介入性门腔分流术治疗门脉高压症所致曲张静脉出血及腹水疗效观察  

Role of transjugular intrahepatic portosystemic shunt in the control of variceal bleeding and ascites due to portal hypertension

作　　者：滕磊磊[1] 吕献军[1] 李选[1] 傅军[1] 王昌明[1] 庄金满[1] 冯琪琛[1] 董国祥[1] 

机构地区：[1]北京大学第三医院介入血管外科,100191

出　　处：《传染病信息》2012年第4期208-212,共5页Infectious Disease Information

摘　　要：目的 评价介入性门腔分流术治疗门脉高压症所致曲张静脉出血及腹水的疗效。方法 回顾性分析2004年2月—2010年1月我院55例良性门脉高压症行介入性门腔分流术患者的临床资料,观察分流道近期和远期的通畅情况,并分析生存时间和并发症。结果 手术成功率为100%,患者门静脉压力梯度(portal pressure gradient,PPG)均达到要求,即PPG≤1.60kPa或PPG降低2.00kPa。术后1～5年生存率分别为70.4%、60.8%、60.8%、60.8%、60.8%;分流道再狭窄率分别为7.3%、13.1%、24.0%、24.0%、24.0%;消化道曲张静脉出血复发率分别为9.8%、19.3%、26.0%、26.0%、26.0%;肝性脑病发生率分别为14.8%、23.9%、35.8%、57.2%、57.2%。结论 介入性门腔分流术治疗门脉高压症所致曲张静脉出血及腹水疗效可靠。如应用覆膜支架,门腔分流道通畅率较高。肝性脑病及复发性出血等并发症的发生率较低。Objective To investigate the efficacy of transjugular intrahepatic portosystemic shunt （TIPS） created with PTFE- covered stents （Fluency） on variceal bleeding and ascites due to portal hypertension. Methods Clinical data of 55 patients with benign liver disease, who had undergone TIPS in our hospital from Feb. 2004 to Jan. 2010, were analyzed retrospectively. Long-term and short-term shunt patency was assessed; the survival time and the incidence of complications were analyzed. Results Technical success rate was 100%. Portal pressure gradients （PPG） of all the patients reached consensus standard （PPG ≤1.60 kPa, or PPG dropped by 2.00 kPa）. The 1-, 2-, 3-, 4-, 5-year survival rates were 70.4%, 60.8%, 60.8%, 60.8% and 60.8%, the 1-, 2-, 3-, 4-, 5-year shunt dysfunction （restenosis） rates were 7.3%, 13,1%, 24.0%, 24.0% and 24.0%, the 1-, 2-, 3-, 4-, 5-year variceal rebleeding rates were 9.8%, 19.3%, 26.0%, 26.0% and 26.0%, and the 1-, 2-, 3-, 4-, 5-year incidence rates of hepatic encephalopathy were 14.8%, 23.9%, 35.8%, 57.2% and 57.2%, respectively. Conclusions TIPS created with PTFE-covered stents is effective for the control of variceal bleeding and ascites due to portal hypertension with high patency rate. The incidence of complications such as hepatic encephalopathy and rebleeding is comparatively low.

关 键 词：高血压 门静脉 食管和胃静脉曲张 门腔分流术 外科 腹水 

分 类 号：R544.1[医药卫生—心血管疾病]