经颈静脉肝内门腔静脉分流术治疗门静脉高压症并发症的疗效分析

Outcomes of transjugular intrahepatic porto-systemic shunt in the treatment of complications of hepatic portal hypertension

目的:分析经颈静脉肝内门腔静脉分流术(TIPS)在门静脉高压症并发症中的临床疗效。方法:回顾性分析2020年10月~2021年8月在弋矶山医院接受TIPS患者的临床资料。共15例患者纳入研究,食管胃底静脉曲张破裂出血10例,顽固性腹水4例,门静脉全程血栓合并腹胀腹水1例。结果:TIPS手术成功率为88.7%(13/15)。食管胃底静脉曲张出血6周控制率为100%(8/8);顽固性腹水消退率为75%(3/4);1例门静脉全程血栓患者术后门静脉恢复通畅,腹胀和腹水消退。随访中,3例患者死亡,其中2例为肝癌伴门脉癌栓,1例为肝功能Child-Pugh C级。结论:TIPS手术是降低门静脉高压症的一种有效手段,尤其治疗食管胃底静脉曲张破裂出血、顽固性腹水和门静脉血栓;并发有肝癌门静脉癌栓患者可能不适合行TIPS手术。

Objective:To analyze the clinical efficacy of transjugular intrahepatic portosystemic shunt(TIPS) in management of the complications from hepatic portal hypertension.Methods:The clinical data were reviewed in 15 patients undergone TIPS procedures in the First Affiliated Hospital of Wannan Medical College between October 2020 and August 2021.Of the 15 cases, 10 were esophagogastric varices bleeding, 4 intractable ascites, and one was portal vein thrombosis with abdominal distension and ascites.Results:The success rate of TIPS was 88.7%(13/15).The 6-week control rate was 100%(8/8) for esophagogastric variceal bleeding, and the regression rate was 75%(3/4) for intractable ascites.Patent portal vein was achieved in one patient of portal vein thrombosis, with subsided abdominal distension and ascites.Three deaths occurred, 2 cases of liver cancer with portal vein tumor thrombus and 1 case of Child-Pugh class C liver function, during follow-up.Conclusion:TIPS is an effective method to reduce hepatic portal hypertension, particularly for the treatment of esophagogastric varices bleeding, intractable ascites and portal vein thrombosis, yet it is not recommended for patients with hepatocellular carcinoma and portal vein thrombus from neoplasm.