TIPSS与PSE并用的价值及可行性初探

Preliminary Investigation on TIPSS Combined with Partial Spleen Embolization to Treat Portal Hypertension

目的：探讨ＴＩＰＳＳ与ＰＳＥ并用的可行性及价值。材料与方法：ＴＩＰＳＳ与ＰＳＥ同时施行者２例，其余４例在ＴＩＰＳＳ复查时进行。直测ＰＳＥ前后门脉压力。检测ＰＳＥ前后白细胞、血小板数值，观察术后并发症情况。结果：ＴＩＰＳＳ及ＰＳＥ后消化道出血停止。门脉压力平均下降５．６ｃｍＨ２Ｏ，脾机能亢进基本缓解，血小板、白细胞均明显上升。ＰＳＥ与ＴＩＰＳＳ同时施行者术后反应较重，而ＴＩＰＳＳ随访时施行ＰＳＥ者术后反应较轻。结论：（１）ＰＳＥ后门脉压力下降，脾面积栓塞５０％～７０％，门脉压力平均下降５．７ｃｍＨ２Ｏ；（２）ＴＩＰＳＳ与ＰＳＥ并用可控制消化道出血，同时治疗脾机能亢进；

Objective: TIPSS combined with PSE to treat portal hepertension and hypersplenism was reported.Materials and Methods:PSE was performed with TIPSS simultaneously for 2 cases while 4 cases were performed in the follw up of TIPSS. Portal vein pressure was directly measured before and after PSE, platelet and leucocyte was test. Complication and reaction was observed.Results:Bleeding was controlled after PSE and TIPSS in all patients, the portal pressure dropped 5.6cmH 2O average, while hypersplenism was completely resolved and leucocyte counts increased significantly. Serious complication and reaction occured on 2 patients in whom PSE and TIPSS were performed at same time, while it was mild on other 4 cases in whome PES were done after 2 months of TIPSS.Conclusion: (1)The portal vein pressure dropped after PSE, if 50%～70% of spleen was embolizationed, the pressure may dropped 5.7cmH 2O average. (2)Portal hypertension with gastrointestinal bleeding and hypersplenism were controlled effectively after PSE and TIPSS. (3)It may be suitable for PSE to be performed in following time of TIPSS.