经颈内静脉肝内门体分流术治疗门脉高压症的临床研究

Clinical Study of Transjugular Intrahepatic Portosystemic Shunt in PortalHyperstenives

采用自制的内支撑行经颈内静脉肝内门体分流术（ＴＩＰＳＳ），对６０例Ｃｈｉｌｄ－ｐｕｇｈ平均评分为１０．０３±２．１４的门脉高压症患者进行治疗，ＴＩＰＳＳ成功率为９４．５％，并发症发生率为１８．２％，死亡率为５．５％；肝内门体分流建立后冠状静脉和食管曲张静脉消失，分流道建于肝右静脉与门静脉左支、右支和左、右支交叉分别为５５．８％、２６．９％和１７．３％；术后一周分流道血流速度为８３．４２±３１．５４ｃｍ／ｓ，术后１～１０月血流速度为８２．５５±３２．４４ｃｍ／ｓ．分流道呈内壁光滑的圆柱形结构；术后１～１０个月随访，出血复发１例，肝功能衰竭死亡１例。研究结果表明：ＴＩＰＳＳ是治疗晚期肝硬化伴食管静脉曲张出血的有效方法，肝硬化时门静脉系统解剖结构和病理生理改变有助于肝内门体分流的建立和分流道的通畅。

Sixty patients of portal hypertension with an average Child-pugh scoreof l0.03±2.14 underwent trasjugular intrahepatic portosystemic stent shunt(TIPSS)with self-made expandable stents.Our overall technical success in 55 patients(except 5Complicated by portal vein thrombosis)was 94.5%. Morbidity and mortality rates were18.2%and 5.5%,respectively. Post TIPSS venogram showed absence of esophagealvarices and patency of shunts. Shunts wereconstructed from the right hepatic vein tothe left portal vein(55.8%);to the right portal vein(26.9%)and to the portal veinbifurcation(17.3%).The velocity of shunt flow was 83.42±31.53%cm/s a week followingTIPSS and was 82.55±32.44cm/s during 1 to 10 months followed-up period.Shuntsvoilta smooth vascular lumen were observed by doppler US a month after TIPSS. During the followed-up period.one patient died of liver failure,variceal rebleedingoccurred in another. The results show TIPSS is an effective means intreatment ofportal hypertension in patients with advanced cirrhosis and the anatomical andpathophysiologic changes of the portal system in cirrhotics facilitate the establishmentof TIPSS and patency of shunts.