TIPSS技术在门脉癌栓性门脉高压中的应用  

The application of TIPSS in portal vein cancerous thrombosis complicated with portal hypertension

作　　者：姜在波[1] 单鸿[1] 关守海[1] 朱康顺[1] 黄明声[1] 李征然[1] 朱文科[1] 刘浪[2] 郭添胜 

机构地区：[1]中山大学附属第三医院放射科,510630 [2]广州市妇婴医院放射科 [3]广州番禺区医院肿瘤科

出　　处：《介入放射学杂志》2002年第2期102-105,共4页Journal of Interventional Radiology

摘　　要：目的　探讨TIPSS技术在治疗门静脉癌栓合并门脉高压中的技术特点及禁忌证。方法16例门静脉癌栓合并门脉高压症患者 ,9例门静脉主干完全堵塞 ,7例门静脉主干及分支有不同程度栓塞 ;6例合并门脉海绵样变 ;1例单纯上消化道大出血 ;4例单纯顽固性腹水 ;11例上消化道大出血合并顽固性腹水。结果　 16例中 11例患者成功行TIPSS治疗 ,技术成功率约 6 8.8% ,门脉压力从术前 4.9kPa降至 2 .4kPa ,平均降低 2 .5kPa ,腹水减少或消失 ,症状缓解 ,平均生存 136d。 5例失败。结论　TIPSS是治疗门脉癌栓引起的上消化道大出血和顽固性腹水的有效方法 ,门脉海绵样变是该术的禁忌证。Objective To discuss the technical skills and the contraindication of transjugular intrahepatic portosystemic shunt stent (TIPSS) in portal vein cancercous thrombosis (PVCT) complicated with portal hypertension. Methods There were 16 cases of PVCT with portal hypertension, and average age of 53.6 yr. There were 9 cases with complete occlusion of portal vein trunk and 7 cases with incomplete thrombosis. There were 5 cases with cavernous transformation of the portal vein(CTPV). 1 case of simple upper gastro intestinal tract (GIT) massive bleeding, 4 with refractory ascites and 11 with upper GIT massive bleeding and refractory ascites. Results The procedure of TIPS was successful in 11 cases, the successful rate reached about 68.8%. The mean portal vein pressure was reduced from 4.9kPa to 2.4kPa with average 2.5kPa reduction. Ascites decreased, bleeding stopped and the clinical symptoms disappeared. The average survival period was 136 days. The procedure failed in 5 cases. Conclusions TIPSS is an effective method to control the bleeding and ascites caused by PVCT. The PV cavernous transformation was the contraindication of TIPSS.

关 键 词：门静脉癌栓 门静脉高压 经颈静脉肝内体分流术 介入治疗 门脉海绵样变 

分 类 号：R730.5[医药卫生—肿瘤]