TIPS治疗肝硬化门静脉血栓的临床疗效  

Clinical efficacy of TIPS in the treatment of portal vein thrombosis in liver cirrhosis

作　　者：陈永慧[1] 李智[2] 陈卫[1] CHEN Yonghui;LI Zhi;CHEN Wei(Department of Intervention Radiology,Huai'an First People's Hospital,Nanjing Medical University,Huai'an 223300,China;Department of Interventional Radiology,First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]南京医科大学附属淮安第一医院介入科,江苏淮安223300 [2]苏州大学附属第一医院介入科,江苏苏州215006

出　　处：《医学影像学杂志》2024年第5期99-102,共4页Journal of Medical Imaging

摘　　要：目的 探讨经颈静脉肝内门体分流术(TIPS)治疗肝硬化合并门静脉血栓(PVT)的临床疗效。方法 选取17例肝硬化合并PVT,并有食管胃底静脉曲张破裂出血患者,对其进行TIPS治疗,术后进行随访6~25个月(平均16个月)。根据手术结果,分析手术治疗成功率、术后血管再通、曲张静脉缓解和再发出血情况。结果 17例患者TIPS手术成功14例,成功率82.3%。术前门静脉主干血栓9例,至随访结束1例未缓解,再通率88.9%,门静脉主干伴有分支血管血栓3例,2例部分缓解;2例伴有肠系膜上静脉血栓,术后均得到缓解。3例手术失败患者均未缓解。14例手术成功患者术后3个月、6个月再发出血分别为1例、2例,出血率为21.4%。术后10例曲张静脉转为轻度或消失,缓解率为76.9%。14例手术成功患者3例术后发生肝性脑病,治疗后好转。所有患者无严重并发症发生。结论 TIPS对于抗凝治疗失败的PVT患者具有非常好的技术成功率及临床疗效,明显提高了门静脉再通率,减少了门静脉高压相关并发症,疗效肯定,可作为一线治疗方法。Objective To investigate the clinical effect of transjugular intrahepatic portosystemic shunt(TIPS)in the treat⁃ment of liver cirrhosis complicated with portal vein thrombosis.Methods A retrospective analysis was conducted on 14 patients with cirrhosis complicated with portal vein thrombosis,and TIPS was given to them.The patients were followed up for 6~25 months(with an average of 16 months)after surgery.According to the results of surgery,the success rate of surgery,postopera⁃tive vascular recanalization,varicose vein remission and rebleeding were analyzed.Results 14 out of 17 patients underwent TIPS surgery successfully,with a success rate of 82.3%.There were 9 cases of main venous thrombosis before surgery,and 1 case remained unresolved until the end of follow-up,with a recanalization rate of 88.9%.There were 3 cases of main portal vein thrombosis accompanied by branch vessels,and 2 cases were partially relieved.2 cases were accompanied by superior mesen⁃teric vein thrombosis,and all were relieved after surgery.All 3 patients who failed the surgery did not improve.14 successful pa⁃tients experienced recurrent bleeding at 3 and 6 months after surgery,with a bleeding rate of 21.4%.After surgery,10 cases of varicose veins turned mild or disappeared,with a remission rate of 76.9%.3 of the 14 successful patients developed hepatic en⁃cephalopathy after surgery,which improved after treatment.No serious complications occurred in all patients.Conclusion TIPS has a very good technical success rate and clinical efficacy for patients with portal vein thrombosis who have failed antico⁃agulation treatment.TIPS significantly improves the rate of portal vein recanalization and reduces complications related to portal hypertension.TIPS has a definite therapeutic effect,which can be used as a first-line treatment method.

关 键 词：经颈静脉肝内门体分流术 门静脉血栓 肝硬化门静脉高压 介入性 放射学 

分 类 号：R575.2[医药卫生—消化系统] R815[医药卫生—内科学]