门静脉置管在门奇静脉断流术治疗门静脉高压症中的作用  

Effect of indwelling portal vein catheter via TIPS route for peri-esophagogastric devascularization in portal hypertension

作　　者：范欣鑫[1] 何长生[1] 曹建民[1] 刘宝晨 丁威威[1] 吴性江[1] 刘凯[1] 

机构地区：[1]南京军区南京总医院普通外科研究所,南京210002

出　　处：《腹部外科》2016年第3期170-173,共4页Journal of Abdominal Surgery

摘　　要：目的探讨经颈内静脉肝内门体分流术(transjugular intrahepatic porto-systemic shunt,TIPS)途径门静脉置管对门奇静脉断流术治疗门静脉高压症疗效的作用。方法 2011年3月至2015年5月,对60例门静脉高压症病人行门奇静脉断流术治疗,术前采用随机方法分为研究组(门静脉直接抗凝)和对照组,每组各30例。采用直接门静脉造影和测压、门静脉CT血管造影(CTA)检查,观察断流术的彻底性、门静脉血栓发生率和门静脉压力的变化。结果门奇静脉断流术后1周,门静脉CTA显示研究组和对照组门静脉血栓发生率分别为6.7%(2/30)和26.7%(8/30),差异有统计学意义(P<0.05);直接门静脉测压示门静脉压力较术前明显下降(P<0.05),术后7 d稍有回升。直接门静脉造影示研究组病人冠状静脉和食管静脉曲张显影4例,采用弹簧栓栓塞。两组病人术中失血量、术后并发症发生率差异均无统计学意义。术后随访,研究组和对照组出血复发率分别为3.3%(1/30)和16.7%(5/30)。门静脉CTA复查示研究组病人冠状静脉无显影,对照组病人显示冠状静咏和食管静脉曲张,TIPS治疗成功4例,失败1例。结论经TIPS途径门静脉置管,直接门静脉造影、冠状静脉栓塞以及抗凝可以提高断流术的彻底性、降低门静脉血栓发生率,同时还能动态观察门静脉压力变化。Objective To evaluate the effect of indwelling portal vein catheter via transjugular intrhepatic portal-systemic shunt （TIPS） route for peri-esophagogastric devascularization in portal hy- pertension. Methods A total of 60 patients with portal hypertension were subjected to peri-esopha- gogastric devascularization. They were randomly divided study group （30 cases） and control group （30 cases）. The portal vein catheters were indwelled via TIPS route before operation in the study group. Direct portal angiography, portal pressure measure and direct anticoagulation treatment with low-mo- lecular heparin were carried out in the study group. The completeness, portal vein thrombosis and changes of pressure measure were observed after peri-esophagogastric devascularization. Results CTA showed the incidence of portal vein thromboses was 6. 7% in the study group and 26. 7% in the control group one week after operation （P〈0. 05）. The portal pressure was significantly reduced after operation （P〈0. 05） and increased slowly at 7th day after the operation. Esophagogastric variees and coronary vein were showed by direct portal angiography in 4 patients of the study group and occluded by coils. There was no significant difference in blood loss and operative complications between the study group and control group. During the follow-up periods, the rebleeding rate after peri-esopha- gogastric devascularization was 3.3 % and 16. 7 % in the study group and control group respectively. Esophagogastric varices and coronary vein were showed by CTA in no patients of study group and in 5 patients of control group. Four patients with rebleeding in the control group were successfully treated by TIPS and one patient was failed. Conclusions Direct portal angiography, portal pressure measure and direct anticoagulation treatment by indwelling portal vein catheter can improve the completeness of peri-esophagogastric devascularization, decrease the incidence of portal vein thromboses and observe the change of portal pressur

关 键 词：门静脉高压症 门奇静脉断流术 门静脉血栓 

分 类 号：R657.34[医药卫生—外科学]