TIPSS在门静脉高压症治疗中的临床价值

The Clinical Value of Transjugular Intrahepatic Portasystemic Stent Shunts in the Treatment of Portal Hypertension

研究经颈内静脉肝内门体分流术(TIPSS)在门静脉高压症治疗中的价值。方法:1993年8月～1998年8月,我院对200例门静脉高压症患者实施TIPSS治疗,其中20例行TIPSS与Sugiura改良术联合治疗。结果:TIPSS的技术成功率为94.59％,术后近期死亡率3.87％,出血复发率2.58％,轻度肝性脑病18.71％。经1至5年随访,出血和腹水复发率分别为27.08％和41.18％,分流道狭窄阻塞率30.77％,死亡率28.46％;TIPSS加改良Sugiura术后经1～24月随访,无出血复发,肝内分流道保持通畅。结论:TIPSS与改良Sugiura术的联合应用,可提高门静脉高压症的临床疗效。

To evaluate the clinical value of transjugular intrahepatic portasystemic stent shunts (TIPSS) in the treatment of portal hypertension. Methods: From August 1993 through August 1998, 200 patients with protal hypertension were treated with TIPSS or TIPSS plus modified Sugiura operation. Results: Except for 10 cases with portal occlusion and 5 cases with hepatocellular carcinoma, the tech-nical successful rate was 94.59%. The mortality and the rate of variceal rebleeding within one month after TIPSS were 3.87% and 2.58% respectively. Slight encephalopathy was observed in 18.71% of ca-ses. One month to 5 years after TIPSS, the rates of variceal rebleeding and recurrence of ascites were 27.08% and 41.18% respectively. The rate of shunt stenosis or occlusion and the late mortality of TIPSS were 37.77% and 28.46% respectively. During the follow-up period of 1~24 months after TIPSS plus modified Sugiura operation, neither variceal rebleeding nor stenosis or occlusion of shunts were observed. Conclusions: The combination of modified Sugiura operation with TIPSS could improve the clinical results in treating portal hypertension.