摘要
目的:总结经颈内静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)治疗慢性门静脉血栓伴食管曲张静脉出血的临床疗效。方法:对53例慢性门静脉血栓伴食管曲张静脉出血病人实施TIPS治疗。采用经典TIPS、经皮经肝门静脉穿刺TIPS和肝动脉引导门静脉穿刺TIPS完成门静脉开通,建立肝内分流道。结果:TIPS治疗慢性门静脉血栓的技术成功率81.1%。其中,门静脉部分、完全阻塞和海绵状变性病人技术成功率分别为100%、76.5%和60.0%,并发症发生率分别为14.3%、23.5%和46.7%。术后随访(48.0±6.2)个月,门静脉部分、完全阻塞和海绵状变性病人2年分流道通畅率80.0%、61.5%和44.4%,肝性脑病发生率15.0%、15.4%和11.1%,出血复发率15.0%、38.5%和33.3%,死亡率20.0%、23.1%和22.2%。结论:TIPS技术成功率和分流道通畅率与门静脉阻塞的严重程度密切相关,在无其他有效措施治疗慢性门静脉血栓伴食管曲张静脉出血时,可选择TIPS。
Objective To assess the effect of transjungular intrahepatic portosystemic shunt（TIPS） in the treatment of chronic portal vein thrombosis with esophageal variceal bleeding.Methods Fifty-three patients of chronic portal vein thrombosis with esophageal variceal bleeding were treated with TIPS procedures.Open of portal occlusion and establishment of intrahepatic shunt were performed by standard TIPS,TIPS assisted with a transhepatic approach and TIPS assisted with guidance of wire in hepatic artery.Results Totally TIPS success rate was 81.1% with success of 100%,76.5% and60.0% in group of patients with portal vein partially occluded,portal vein completely occluded and cavernous transformation,respectively.The complications in 3 groups were 14.3%,23.5% and 46.7% respectively.During the follow-up period of（48.0 ±6.2） months,the two year-shunt patency of portal vein was 80.0%,61.5% and 44.4% in 3 groups.Occurrence of hepatic encephalopathy was seen in 15.0%,15.4% and 11.1% of patients and recurrence of bleeding 15.0%,38.5% and 33.3% in 3 groups respectively.The mortality was similar in 3 groups（20.0%,23.1% and 22.2%）.Conclusions Successful TIPS insertions and shunt patency of portal vein were associated with degree of portal occlusion.TIPS may be considered as an option for patients of chronic portal vein thrombosis with esophageal variceal bleeding when there is no other effective treatment.
作者
吴性江
曹建民
范鑫欣
丁威威
何长生
刘宝晨
WU Xingjiang CA O Jianmin FAN Xinxin DING Weiwei HE Changsheng LIU Baochen(Department of General Surgery, Nanjing General Hospital of Nanjing Military Region, PLA, Jiangsu Nanjing 210002, China)
出处
《外科理论与实践》
2016年第5期389-394,共6页
Journal of Surgery Concepts & Practice
关键词
慢性门静脉血栓
门静脉高压症
经颈内静脉肝内门体分流术
Chronic portal vein thrombosis
Portal hypertension
Transjugular intrahepatic portosystemic shunt
