经颈静脉肝内门腔分流术的临床研究

Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS): Clinical Study

目的：对ＴＩＰＳＳ的临床应用资料进行分析和总结，评价其近、中期临床应用效果，以寻求进一步提高疗效的途径。材料与方法：分析４０例ＴＩＰＳＳ的临床应用结果，比较及统计了各项术前、术后资料，评价其近、中期疗效。结果：ＴＩＰＳＳ对门脉高压出血有可靠的止血效果。脾机能亢进改善不明显。术后早、中期对肝功能有影响。高动力循环有所加重。肝性脑病轻，大多易于控制。术前、后肝功能分级无明显改善。中、长期疗效与分流道狭窄及肝功能代偿能力有关。严格掌握适应症，根据情况控制分流量，结合曲张静脉栓塞，可减少并发症。结论：ＴＩＰＳＳ是控制门静脉高压出血的有效手段。改善分流道血流动力学特性、定期复查及时处理并发症，可提高疗效。

Objective: To analyse the short and longterm clinical results of TIPSS and discuss on some main ways benificial to further improvement of its efficacy.Materials and Methods:The clinical materials of 40 cases before and after TIPSS procedures were analysed statistically and its shortand longterm results were evaluated.Results:TIPSS proved to be effective in controlling hemorrhage induced by portal hypertention, but no obvious effects were found in the treatment of splenomegaly and secondary cytopenia. Some patients showed deteriorations of liver function and highdynamic circulation. Most episodes of hepatic encephalophathy were mild and responded well to medical therapy. No improvements were found in Childpugh scores before and after TIPSS. Midand longterm results were influenced by shunt patency and the compensibility of liver function. The procedure related to complications could be reduced by reliable guidances using sonography and intraaterial marker during PV puncture. The outflow HV stenosis could be reduced by improvement in hemodynamic feathers of the shunt with flexible stents. Enough outflow diameter could be maintatine by stenting to the long and narrow hepatic veins.Conclusion: TIPSS was effective in controlling of variceal hemorrhage. With proper surveillance, longterm patency of the shunts with good hemodynamic state could be maintained.