经颈静脉肝内门体分流术预防门静脉海绵样变食管胃底静脉曲张再出血的临床应用

Transjugular intrahepatic portosystemic shunt for the prevention of gastroesophageal variceal rebleeding in patients with cavernous transformation of portal vein

目的初步评估经颈静脉肝内门体分流术(TIPS)用于预防门静脉海绵样变(CTPV)患者食管静脉曲张再出血的可行性、有效性和安全性。方法选取2011年1月至2016年12月在山东省立医院住院,诊断为CTPV且合并食管静脉曲张出血史,行TIPS预防再出血的患者67例,纳入回顾性分析并随访。总结技术成功率、并发症发生率、再出血、支架通畅、肝性脑病及生存情况。结果在67例CTPV患者中,56例(83.6%)患者成功行TIPS术。单独通过颈静脉入路15例,经颈静脉联合经皮经肝入路33例,经颈静脉联合经皮经脾入路8例。TIPS术后平均门-体静脉压力梯度,从(28.09±7.28)mmHg降至(17.53±6.12)mmHg(P<0.01)。平均随访(23.91±12.35)个月,累计无出血率87.0%,支架通畅率81.5%,肝性脑性发生率27.8%,累计生存率88.9%。11例未成功行TIPS术的患者中死亡4例,再次出血4例。结论TIPS用于预防门静脉海绵样变性患者食管静脉曲张再出血,是一种安全、可行、有效的方法。

Objective To evaluate the feasibility,efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS)in preventing gastroesophageal variceal rebleeding in patients with cavernous transformation of portal vein(CTPV).Methods A total of 67 patients who were diagnosed as CTPV and with a history of esophageal varices bleeding,and who underwent TIPS to prevent rebleeding from January 2011 to December 2016 in Shandong Provincial Hospital were selected for retrospective analysis and follow-up.The technical success rate,complication rate,rebleeding,stent patency,hepatic encephalopathy and survival were summarized.Results TIPS was successfully performed in 56(83.6%)of the 67 CTPV patients.There were 15 cases via a transjugular approach alone,33 cases via a combined transjugular/transhepatic approach,and 8 cases via a combined transjugular/transsplenic approach.After TIPS the mean portosystemic pressure gradient(PSG)decreased from(28.09±7.28)mmHg to(17.53±6.12)mmHg(P<0.01).The mean follow-up was(23.91±12.35)months.The cumulative non-bleeding rate was 87.0%,the stent patency rate was 81.5%,the hepatic encephalopathy incidence was 27.8%,and the cumulative survival rate was 88.9%.Among the 11 patients who did not receive TIPS successfully,4 died and 4 rehemorrhaged.Conclusion TIPS is a safe,feasible and effective method for preventing gastroesophageal variceal rebleeding in patients with CTPV.