TIPSS在门静脉高压症急性上消化道出血治疗中的应用

The emergency management of variceal bleeding from portal hypertension with TIPSS

作者采用经颈静脉肝内门腔内支架分流术(TIPSS)治疗12例门静脉高压症上消化道出血。其中6例同时经肝内门腔分流途径行食管胃底静脉硬化栓塞术(SEEV)。术后12例出血均立即停止。术后2例发生肝性脑病,4例因 TIPSS 分流通道狭窄、闭塞而发生再出血。4例中,3例经对肝内分流通道实施球囊扩张和/或置入另一组支架后再无出血发生。本组6例死亡,其死因分别为多器官衰竭、肝功能衰竭以及术后再出血。文中对 TIPSS 在门静脉高压症上消化道出血急诊救治中的价值进行了讨论。

The results of 12 patients with active variceal bleed- ing from cirrhotic portal hypertension treated with TIPSS were reported.6 patients were also trated with sclerotic embolization of esophagogastric variceal (SEEV)simultaneously in TIPSS.After the operation bleeding stopped immediately in all 12 patients.2 pa- tients developed encephalopathy.4 patients had stenosis and/or occulution of the shunts after TIPSS,3 of them were successfully treated by second interventional treat- ment.6 patients died of multiorgan failure,liver failure and/or rebleeding.The authors disscuss the value of TIPSS used in the emergency treatment.