改良TIPS治疗门静脉高压急性上消化道出血疗效观察  

Clinical efficacy of improved TIPS therapy in portal hypertension with acute upper gastrointestinal bleeding

作　　者：胡文军 郑楠 曹彭钢 王有枝 肖叶玉[2] 

机构地区：[1]东莞市第五人民医院介入科,广东东莞523900 [2]汕头大学第二附属医院影像科,广东汕头515041

出　　处：《实用放射学杂志》2018年第1期98-100,125,共4页Journal of Practical Radiology

摘　　要：目的 探讨经皮门静脉穿刺改良经颈内静脉肝内门体分流术（T IPS）治疗门静脉高压急性上消化道出血临床疗效.方法选择因急性上消化道出血采用超声引导下经皮门静脉穿刺改良 T IPS技术治疗28例,统计并分析患者术前及术后临床资料、实验室指标和血流动力学变化情况.结果 28例患者TIPS术1次操作成功率及术后24 h的止血率均为100%;2例（7.14%）发生轻度肝性脑病.患者TIPS术后血清白蛋白浓度明显增高,而总胆红素及谷丙转氨酶（ALT）浓度降低,差异均有显著性差异（P〈0.01）.患者门静脉压力（PVP）术前与术后分别为（41.48 ± 3.72）mmHg和（28.91 ± 2.59）mmHg,而肝静脉压力差（HVPG）分别为（20.30 ± 2.76）mmHg和（8.81 ± 2.04）mmHg,术后较术前均显著性降低（P〈0.01）.结论 改良TIPS术用于急性肝硬化食管胃静脉曲张破裂出血可以获得良好的临床疗效及安全性.Objective To discuss the clinical efficacy of improved TIPS of percutaneous portal vein puncture in treatment of acute upper gastrointestinal bleeding induced by portal hypertension.Methods 28 patients with acute upper gastrointestinal bleeding underwent improved TIPS therapy in our hospital were enrolled.The clinical data,laboratory parameters and hemodynamic changes were collected and analyzed before and after operation.Results The success rate for the first time and hemostatic rate of postoperative 24 hours in all patients was 100%.2（7.14%）patients underwent mild hepatic encephalopathy.After TIPS operation,the concentration of serum albumin increased,whereas,concentration of total bilirubin and alanine aminotransferase decreased（P〈0.01）.Portal vein pressure （PVP）of pre-and post-operation was（41.48 ± 3.72）mmHg and（28.91 ± 2.59）mmHg,and the hepatic venous pressure gradient （HVPG）was（20.30 ± 2.76）mmHg and（8.81 ± 2.04）mmHg.PVP and HVPG were both decreased significantly after operation（P〈0.01）.Conclusion Improved TIPS therapy can obtain good clinical efficacy and safety for esophageal and gastric varicose bleeding in acute cirrhosis.

关 键 词：经皮门静脉穿刺 经颈内静脉肝内门体分流术 肝硬化 食管胃静脉曲张 出血 

分 类 号：R815[医药卫生—放射医学] R575.2[医药卫生—临床医学]