经颈静脉肝内门体分流术治疗肝硬化门脉高压症

TREATMENT OF PORTAL HYPERTENSION OF LIVER CIRRHOSIS WITH TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT SHUNT

１０例肝硬化门脉高压症患者接受经颈静脉肝内门体分流术（ＴＩＰＳＳ），９例成功，１例失败。建立分流后门脉压从术前的（３．９１±０．５１）ｋＰａ降至（２．２５±０．３１）ｋＰａ（Ｐ＜０．０１）；门脉主干的血流速度从术前（１５．８０±７．１０）ｃｍ／ｓ增至（４６．７３±５．９８）ｃｍ／ｓ。呕血、黑便得到控制，脾脏不同程度的缩小，腹水在术后３～５ｄ内明显吸收。９例随访３个月～２年６个月，术后３个月内无１例再出血，１年内再出血２例，出现肝性脑病２例，分流道狭窄１例，阻塞１例。ＴＩＰＳＳ创伤小、成功率高、适应症广。

Ten cases of cirrhosis with portal hypertension were treated with transjugular intrahepatic portosystemic stent shunt (TIPSS). It was effective in 9 of 10 patients, the portal pressure before and after shunt were (3.91±0.51) kPa and (2.25±0 31) kPa respectively,and were also statistically signifcant (P<0.01),maximal blood flow velocity in the main trunk increased from (15.80±7.10) cm/s. to (46.73±5.98) cm/s. Thus, hemorrhage of gastroesophageal vein was controled, splenomegaly gradually reduced,ascites was absorbed. follow up from 3 months to 2 and half year were done in 9 of the 10 cases. The results showed that no bleeding reoccurred in all patients within 3 months. 2 patients had rebleeding, 2 had encephalopathy, 1 had shunt occlusion and 1 had shunt stenosis within 12 months. In conclusion :the trauma of TIPSS was less but succesful rate was higher. It can be used for many diseases and is an effective method for treatment of late liver cirrhosis.