摘要
报告８６例经颈静脉肝内门腔静脉内支架分流术（ＴＩＰＳＳ）的临床应用结果，主要探讨与建立分流道有关的技术问题和影响疗效的因素。８６例中男６８例，女１８例，年龄２２～７４岁（平均４８岁），７１例有明确的乙型肝炎病史，６９例有一次以上呕血或黑便史，５８例曾接受一次以上经内镜注射硬化剂治疗，６例因大出血不止行急诊ＴＩＰＳＳ。全部病例有中度以上食管胃底静脉曲张。结果：７８例成功，８例失败，无死亡并发症。建立分流后门脉压从术前的４０．５±３．０ｃｍＨ＿２Ｏ＝（１ｃｍＨ＿２Ｏ＝０．０９８ｋＰａ）降至２４．０±３．５ｃｍＨ＿２Ｏ，Ｄｏｐｐｌｅｒ超声显示门脉主干血流速度从术前１２．０＋±．５ｃｍ／ｓ增至４８．５±１４．５ｃｍ／ｓ。术后随访观察２～１６个月（平均８个月），分流道早闭２例，３例术后２个月死于其他原因，７例失去联系，其余６６例有定期随访记录，其中３６例随访在６个月以上。术后半年内复发出血６例，经造影证实为分流道狭窄２例（经再通成功）、阻塞２例，１例内镜检查仍见重度静脉曲张，未行进一步检查，１例为非静脉曲张性出血；静脉曲张消失或减轻后再次出现３例，发生于术后４～７个月，超声波检查均提示分流道狭窄，２例造影证实分流道狭?
The authors retrospectively analyzed 86 cases of TIPSS focused on the puncture technique,.the effectiveness and various influential factors. 68 patients were male,and 18,female with mean age of 48 years(range,22-74 years).71 patients had history of hepatitis B. 69 cases had recurrent bleeding from gastro-eseophageal varices,58 of them received more than once endoscopic sclerotherapy. 6 patients were treated on an emergency basis because of massive active bleeding. All patients had obvious gastroeseophageal varices. TIPSS was technically successful in 78 of 86 pa- tients,no death was associated with the procedure. Portal vein pressure was reduced from 40.5± 3. 0cmH_2O(1cmH_2O=0.098kPa) before to 24.0±3.5cmH_2O after shunting,Doppler US revealed that the maximum blood flow velocity in the main portal vein increased from 12.0±4.5cm/s to 48.5 ±14,5/s. The mean follow-up time in the successful cases was 8 months(range,2-16 months).Shunt occlusion was found in 2 patients 1 month after TIPSS.3 patients died unrelated to the proce- dures at 2 months. 7 cases were lost to follow up and the remaining 66 patients had regular follow up records,6 patients had recurrence of gastrointestinal bleeding within six months,the cause was 8hunt occlusion in 2 cases and shunt stenosis in another 2 whchwere reintervented successfully. Variceal bleeding was confirmed in 1 case by endoscopy,another bleeding was unrelated to varices. Varices recurred but without recurrent bleeding in 3 patients 4～7months after shunting. Angiogra- phy revealed>70%stenosis in 2 cases, which were successful treated.Shunt patency was determined by color Doppler US in the remaining patients.The overall primary patency was 87.9%;Angioplasty and stent placement in the stenotic shunt resulted in a secondary patency of 93.9%. The results sug- gested that TIPSS is a relatively safe and effective means of lowering portal pressure and controlling variceal bleeding. The immediate and short-term results were mainly affected by improper stent placement and some unfavourable configuration of the stent.The shunt stenosis and occlusion oc-curred most frequently at the hepatic vein insertion site due to intimal hyperplasia which played an important role in middle and long term therapeutic effect.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
1994年第12期800-807,共8页
Chinese Journal of Radiology
关键词
经颈静脉
肝
介入疗法
门腔静脉分流
疗效
Hypertension,portal vein Portosystemic shunt Liver Interventional ra- diology
