经颈内静脉肝内门体分流术治疗肝硬化门脉高压140例分析

Transjugular Intrahepatic Portosystemic Shut in the Treatment of 140 Cases with Cirrhotic Portal Hypertension

目的探讨经颈内静脉肝内门体分流术(TIPS)治疗肝硬化门脉高压的疗效及安全性。方法回顾性分析140例经TIPS治疗肝硬化门脉高压患者的临床资料,记录术前术后门静脉压力、门静脉和脾静脉直径、食道胃底静脉、腹水的变化,观察术后肝性脑病、复发出血、支架再狭窄等并发症。结果手术成功率及即刻止血率100%,门静脉压力术前(44.7±3.5)cm H2O,术后(23.6±3.8)cm H2O(P<0.01),门静脉主干直径术前(1.64±0.035)cm,术后(1.27±0.047)cm(P<0.01),脾静脉直径术前(1.26±0.027)cm,术后(0.95±0.023)cm(P<0.01)。肝性脑病发生率13.6%(19/140),腹水好转率89%(65/73),术后12个月复发再出血8.6%(12/140),支架再狭窄15.7%(22/140)。结论 TIPS是治疗肝硬化门脉高压的有效方法,能有效降低门静脉压力,控制上消化道出血。

Objective To discuss the curative effect and safety of transjugular intrahepatic portosystemic shut（TIPS） in the treatment of cirrhotic portal hypertension. Methods A retrospective analysis was made to the clinical data of 140 cases with cirrhotic portal hypertension treated by TIPS; the changes of portal vein pressure, the internal diameters of portal and splenic veins, esophageal and gastric varices and ascites before and after TIPS were recorded and the occurrence of complications after treatment, such as hepatic encephalopathy, recurrent variceal bleeding, and in-stent restenosis was observed. Results The successful rate and immediate hemostatic rate both reached 100%; the portal vein pressure before and after TIPS was 44.7±3.5 cm H2 O and 23.6±3.8 cm H2 O respectively（P〈0.01）; the internal diameter of portal vein before and after TIPS was 1.64±0.035 cm and 1.27±0.047 cm respectively（P〈0.01） while that of splenic vein was 1.26±0.027 cm and 0.95±0.023 cm respectively（P〈0.01）; the occurrence of hepatic encepholopathy was 13.6%（19/140） and the improvement rate of ascites was 89%（65/73）; the recurrent rate of variceal bleeding within 12 months after TIPS was 8.6%（12/140） and the occurrence of in-stent restoenosis was 15.7%（22/140）. Conclusions TIPS is effective on cirrhotic portal hypertension, it can reduce the portal vein pressure and control the upper gastrointestinal bleeding.