经颈静脉肝内门-体静脉分流术同时行胃冠状静脉及胃短静脉栓塞术治疗肝硬化门脉高压并消化道出血  

TIPSS with Gastric Coronary and Short Veins Embolization for the Treatment of Cirrhotic Portal Hypertension and Digestive Tract Bleeding

作　　者：崔进国[1] 梁志会[1] 周桂芬[1] 潘新元[1] 田惠琴[1] 

机构地区：[1]白求恩国际和平医院放射科,石家庄050082

出　　处：《临床放射学杂志》2003年第6期501-503,共3页Journal of Clinical Radiology

摘　　要：目的　评价经颈静脉肝内门 体静脉分流术同时行胃冠状静脉及胃短静脉栓塞术治疗肝硬化门脉高压并消化道出血的效果。资料与方法　对 81例肝硬化门脉高压并消化道出血患者应用经颈静脉肝内门 体静脉分流术同时行胃冠状静脉及胃短静脉栓塞术进行治疗 ,其中男 6 1例 ,女 2 0例 ,年龄 32～ 74岁。所有患者均有 1～ 3次消化道出血史 ,合并脾大及脾功能亢进者 5 8例 ,有腹水者 30例。门静脉穿刺成功后首先行脾静脉造影 ,以明确胃冠状静脉、胃短静脉的部位及曲张情况 ,将 5FCobra导管超选入胃冠状静脉 ,注入 5 %鱼肝油酸钠进行栓塞 ,对曲张静脉直径较大的不锈钢圈加强栓塞以防再通。如胃短静脉参与构成胃底静脉的曲张一并栓塞 ,然后建立TIPSS分流道。为评价此项治疗与单纯行分流术对控制再发出血的疗效 ,笔者随机抽取资料完整的、单纯行分流术的 6 4例患者作为对照组进行研究。结果　 81例技术操作全部成功 ,均达到止血效果 ,无严重并发症。随访 1～ 1 2个月有 5 1人次来我院行上消化道造影 ,造影可见食管胃底静脉曲张明显减轻。术后 1 0个月内有 7例发生分流道狭窄 ,并再次发生少量消化道出血 (7/ 81 ,占 8.6 % ) ,对照组再发消化道出血 1 0例 (1 0 / 6 4 ,占 1 5 .6 % )。结论　经颈静脉肝内门 体静脉分流?Objective To evaluate transjugular intrahepatic portosystemic stent shunt (TIPSS) together with embolization of gastric varicosity in the treatment of cirrhotic portal hypertension and digestive tract bleeding.Materials and Methods TIPSS plus embolization of gastric varicosity was performed in 81 patients (61 males and 20 females, aged 32～74 years) with cirrhotic portal hypertension and digestive tract bleeding. All patients experienced 1～3 episodes of digestive tract bleeding. Hypersplenism was accompanied in 58 cases, and ascites in 30 cases. After the puncture of the portal vein was accomplished, splenic venography was carried out to identify the varicosity of the gastric coronary and short veins. A 5F Cobra catheter was super selectively catheterized into gastric coronary vein, 5% sodium morrhuate was injected via the catheter to embolize the varicosity, additional spring coil was used to strengthen the embolization in cases with larger varicose veins. Gastric short vein was embolized too if it participated in the developing of varicosity. Then, TIPSS was established. Sixty four patients receiving TIPSS only were selected as control group.Results The procedure was successful in all 81 patients. The bleeding was immediately stopped and no serious complications occurred. During a following up period of 1～12 months, 51 patients underwent GI exam, showing a marked relief of esophageal and gastric varicosity. Stenosis of the shunt stent with small amount digestive tract bleeding occurred in 7 patients (8.6%) within 10 months after the surgery. Reoccurrence of digestive tract bleeding in the control group was seen in 10 cases (15.6%). Conclusion TIPSS with embolization of gastric varicosity can effectively stop digestive tract bleeding and, thus, is the most reasonable interventional method for the treatment of cirrhotic portal hypertension and digestive tract bleeding.

关 键 词：肝硬化 门脉高压 消化道出血 经颈静脉肝内门-体静脉分流术 胃冠状静脉 

分 类 号：R575.21[医药卫生—消化系统]