经颈内静脉肝内门体分流术治疗门脉高压

Portal Hypertension Treated by Transjugular Intrahepatic Portosystemic Stent Shunt

评价经颈内静脉肝内门体分流术治疗门脉高压症的应用价值。方法采用ＲＵＰ－１００穿刺导管系统对１０例门脉高压患者经右颈内静脉宽刺，建立静脉脉和肝静脉之间肝内通道后置入血管同人支架。

Objective To evaluate the clinical effect of transjugular intrahepatic portosystemic stent shunt (TIPSS) on portal hypertension.Methods 10 patients were catheterized via transjugular approach to create an intrahepatic tract between hepatic vein and portal vein, and then an expandable metal prosthesis was deployed across it.Results 8 cases successed as shown by: (1)Post TIPSS venogram showed absence of esophageal varices in 1 case, significant reduction in 2 cases,and slight reduction in 2 cases; (2)Free portal vein pressure (FPP) was reduced from 3.81±0.60 kPa to 2.84±0.24 kPa (P<0.001); the portal veinhepatic vein pressure gredient (PHG) was reduced from 3.07±0.64 kPa to 1.54±0.40 kPa (P<0.001); the portal vein diameter (PVD) decreased from 15.13±1.55 mm to 13.63±0.92 mm (P<0.01); the portal vein flow velocity (PVV) increased from 12.89±3.66 cm/s to 19.71±5.20 cm/s (P<0.01); (3)Early clinical results and followup (16 months) findings were satisfactory, showing complete resolution of ascites in 4 cases, obvious shrinkage of enlarged spleen in 3 cases and patent stent shunts observed by Doppler Us in all cases.The patients remained free of recurrent variceal bleeding and ascites.Hepatic capsular hematoma related to the procedure was seen in 1 case; mild and moderate hepatic encephalopathy was observed in 1 case, respectively.One patient died of acute hepatic failure two weeks following TIPSS.Conclusion TIPSS creation is an effective and reliable nonoperative means for controlling variceal bleeding and treating ascites, but longterm clinical results required further followup.