经颈静脉肝内门脉左支-体静脉分流术的临床意义

The clinical significance of transjugular intrahepatic portosystemic shunt by left branch of portal vein

目的 评价选择性门静脉左支作为 TIPS分流道的临床意义 ,分析门静脉左、右支的血液动力学变化及重要液递物质浓度差异对术后预防肝性脑病及远期疗效的影响。 方法 34 1例有目的地选择肝内门静脉左支作为穿刺靶点 ,行经颈静脉肝内门静脉左支门腔分流术建立门腔分流道 ,避开富含营养、毒素的门静脉右支血液。肝实质通道用 8mm直径球囊扩张 ,限制分流口径。 结果 所有患者术后 3个月内无一例发生肝性脑病。随访期间 TIPS术后 34 1例患者仅 5例 (1.47%)出现肝性脑病和 19例 (5 .5 7%)一年随访造影出现支架内狭窄。 结论 选择性门静脉左支作为门腔静脉分流道 ,可以显著降低肝性脑病发生率 ,对保护肝功能、提高分流道远期开通率具有重要的临床意义。

Objective To evaluate clinical significance of transjugular intrahepatic portosystemic shunt (TIPS) by left branch of portal vein and analyse hemodynamics of both branch of portal vein and observe long-term results in the prevention of encephalopathy. Methods To puncture left branch of portal vein purposively and create TIPS. To keep away from the right branch of portal vein blood that contain nutrition and toxin. Results All patients with TIPS procedure did not occur encephalopathy within 3 months. Of the 341 patients of follow-up, only 5 patients(1.47%)occurred encephalopathy and 19 patients(5.57%)shunt abnormalities were detected at routine follow venography. Conclusion Selectivitive portosystemic shunt by left branch of portal vein can decrease encephalopathy obviously and protect liver function.