经皮经肝穿刺肝内门体分流术联合胃冠状静脉栓塞治疗食管胃底静脉曲张  

Percutaneous transhepatic intrahepatic portosystemic shunt plus embolotherapy for treatment of gastroesophageal varices

作　　者：邓小军[1] 张宏文[1] 彭秀达[1,2] 孙鑫国[1] 段诗姣[1] 谢卫华[1] 刘琼[1] 

机构地区：[1]南华大学附属南华医院介入科,湖南省衡阳市421002 [2]南华大学附属南华医院普外科,湖南省衡阳市421002

出　　处：《世界华人消化杂志》2014年第13期1858-1862,共5页World Chinese Journal of Digestology

摘　　要：目的:评估经皮经肝穿刺肝内门体分流术(percutaneous transhepatic intrahepatic portosystemic shunt,PTIPS)联合胃冠状静脉栓塞术治疗食管胃底静脉曲张的疗效.方法:对我院2009-05/2012-5 15例肝硬化食管胃底静脉曲张患者行PTIPS联合胃冠状静脉α-氰基丙烯酸(TH胶)栓塞术治疗.结果:PTIPS联合胃冠状静脉栓塞术的技术成功率为100%,术前门静脉压力40.25 cmH2O±4.86 cmH2O(l cmH2O=0.098 kPa)降至24.79cmH2O±5.21 cmH2O,(t=20.324,P<0.01).造影见食管胃底曲张静脉消失,术后患者肝功明显改善,食管胃底静脉曲张程度明显减轻.随访6-12 mo,其中3例患者术后出现肝性脑病,经对症治疗后缓解,1例患者术后出现分流道狭窄,再次置入支架后狭窄再通,1例出现肋间动脉损伤出血,经栓塞后好转.随访期内无再次食管胃底静脉曲张破裂出血发生.结论:PTIPS联合胃冠状静脉栓塞术能有效降低门静脉压,控制并预防食管胃底静脉曲张破裂出血,是常规经颈静脉肝内门体分流术的有效补充,为门脉高压症患者的肝内门体分流提供了是一种安全、有效的治疗方法,具有重要的临床应用价值.AIM： To evaluate the efficacy of percutaneous transjugular intrahepatic portosystemic shunt （PTIPS） plus embolotherapy in the treatment of gastroesophageal varices. METHODS： A total of 15 patients with gastroesophageal varices underwent PTIPS plus embo-lotherapy from May 2009 to May 2012 at the Affiliated Nanhua Hospital of Nanhua University. RESULTS： The technical success rate of PTIPS plus embolotherapy was 100%. The portal vein pressures declined from 40.25 cmH20 ± 4.86 cmH2O （1 cmH2O = 0.098 kPa） preoperatively to 24.79 cmH20 ± 5.21 cmH2O, t = 20.324, P 〈 0.01） postoperatively. Angiography showed that gastroesophageal varices disappeared in all patients. Both liver function and gastroesophageal varices were markedly improved. During the follow-up period of 6-12 mo, 3 cases developed hepatic encephalopathy, 1 case developed stent restenosis and 1 case developed intercostal artery bleeding. Most cases recorded after treatment. No rebleeding occurred during the followup period.CONCLUSION： PTIPS plus embolotherapy can effectively lower portal vein pressure and cure gastroesophageal variceal bleeding. PTIPS plus embolotherapy is safe and effective in the treatment of portal hypertension with exceptionally challenging anatomy.

关 键 词：门体分流术 栓塞 食管和胃静脉曲张 介入性 

分 类 号：R657.34[医药卫生—外科学]