经颈静脉途径肝内门体分流术的临床应用

Transugular intrahepatic portosystemic stent shunts: Results in l02 pa-tients

１０２例经颈静脉途径肝内门体分流术（ＴＩＰＳＳ）的应用结果，主要探讨操作技术问题和影响食管静脉曲张出血疗效的因素。结果：９２例成功，８例失败，成功率为９２．２％。分流后，门脉压从术前３．９７±０．４４ｋＰａ降至２．３０±０．３４ｋＰａ。Ｄｏｐｐｌｅｒ超声显示：门脉主干血流速度，从术前１４．０±４．５ｃｍ／ｓ增至４６．５±１４．５ｃｍ／ｓ。８１例随访３～１８个月（平均８．５个月）．分流道狭窄６例、阻塞３例，再通成功５例。随访病例的首次通畅率为８８．９％，第二次处理后的通畅率为９５．１％。结论：ＴＩＰＳＳ创伤性较小，降低门脉压可靠，是治疗门脉高压症的优良方法，其远期疗效有待进一步观察。

The authors retrospectively analyzed 102 cases of TIPSS focusing onthe technique,the effectiveness and factors affecting the procedure,All patients hadobvious gastroeseophageal varices,among them 88 had recurrent bleeding.The shuntswere successfully constructed in 94 patients without death attributable to theprocedure. Portal pressure was reduced from 3.97±0.44kPa to 2.30±0.34kPa aftershunting. Doppler ultrasonography revealed the maximum blood flow velocity in themain portal trunk increased from 14.o±4.5cm/sec to 46.5±14.5/sec. 8l patients werefollowed-up,the mean follow-up period in the successful cases was 8.5 months(range3～18 months).Stenosis and occlusion were found in 9 patients,6 of them hadrecurrence of bleeding,and 5 of them were retreated successfully with dilatation andreplacement by a stent.The patency of shunt was deterlnined by color Dopplerultrasonography in the remaining cases who had no rebleeding.The overall primarypatency was 88.9%,angioplasty and stent placement in the stenotic shunt resulted in asecondary patency of 95.1%,The results suggest that TIPSS is relatively safe andeffective for lowering the portal pressure and controlling the variceal bleeding,andlong term effects would await further investigation.