摘要
目的探讨经颈静脉肝内门腔静脉内支架分流术(TIPS)治疗门脉高压症的技术操作、并发症及其疗效。方法肝炎后肝硬变患者5例,采用介入放射学技术-TIPS治疗门脉高压症。结果 5例全部成功。分流后门脉压从术前3.90±0.07kPa降至2.36±0.36 kPa。随访3-12个月,分流道通畅,食管胃底静脉曲张消失或明显减轻,胸腹水消失或明显减轻。术后一过性肝功能异常及肝性脑病,与肝血流变化及门脉主干血流速度变化有关。结论 TIPS治疗门脉高压症成功率高,创伤小,降低门静脉压可靠;近中期疗效满意。肝血流、门静脉主干血流速度监测有助于预测并发症的发生。术后抗凝、抗肝昏迷可提高疗效。
AIMS To study the transjugular intrahepatic portosystemic stent shunts (TIPS) in the treatment of portal hypertension and its technical manipulation, complications and efficacy. METHODS Intereventional radiologic technique-TIPS was used to treat 5 patients with portal hypertension. RESULTS Shunts were successful in all 5 cases. Portal vein pressure dropped from 3.90±0.07 kPa before shunting to 2.36±0.36 kPa after shunting. In 3-12 months follow-up, shunts were patent, gastroesophageal varices disappeared or significantly abated, and pleural effusion as well as ascites vanished or lessened. Transient hepatic disfunctions and hepatic encephalopathy after shunting were associated with allterations of hepatic blood flow and blood velocity in the main portal vein. CONCLUSIONS The therapeutic procedure of TIPS treatment for portal hypertension has high successful rate, less injury, reliable decompression of portal vein pressure, and satisfactory efficacy of short and intermediate term. Monitoring of hepatic blood flow and blood velocity of the main portal vein is available for predicting complications. Anticoagulation and treatment for hepatic coma might increase efficacy.
关键词
门脉高血压
门腔分流术
门静脉
外科手术
radiology, interventional hypertension, portal portacaval shunt, surgical
