经颈内静脉肝内门体分流术在慢性门静脉血栓伴食管曲张静脉出血患者中的临床应用价值

The Clinical Application Value of Transjugular Intrahepatic Portosystemic Shunt in Patients with Chronic Portal Vein Thrombosis and Esophageal Variceal Bleeding

目的探讨经颈内静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)在慢性门静脉血栓伴食管曲张静脉出血患者中的应用价值。方法选取2023年1月至2023年10月河南省人民医院重症医学科接收治疗的100例慢性门静脉血栓伴食管曲张静脉出血患者,其中40例门静脉部分阻塞、14例门静脉完全阻塞、28例门静脉完全阻塞伴海绵状变性,18例门静脉完全阻塞伴急性肠系膜上静脉(superior mesenteric vein,SMV)血栓。对患者实施经颈内静脉肝内门体分流术治疗,观察手术成功率和并发症发生率。结果本研究中,TIPS手术技术治疗成功率为82.0%(82/100),门静脉部分阻塞患者的治疗成功率为100%(40/40)、完全阻塞者为71.43%(10/14),门静脉完全阻塞伴SMV血栓者为77.78%(14/18),门静脉完全阻塞伴海绵状变性者为64.29%(18/28),术后并发症分别为15.0%(6/40)、28.57%(4/14)、44.44%(8/18)、42.86%(12/28)。结论慢性门静脉血栓伴食管曲张静脉出血患者的TIPS治疗中,慢静脉阻塞程度对治疗成功率和分流道通畅率有直接影响,患者在不具备选择其他有效治疗时,可以选择TIPS治疗。

To explore the application value of transjugular intrahepatic portosystemic shunt(TIPS)in patients with chronic portal vein thrombosis and esophageal variceal bleeding.Methods From January 2023 to October 2023,100 patients with chronic portal vein thrombosis complicated with esophageal variceal bleeding were selected,including 40 patients with partial portal vein occlusion,14 patients with complete portal vein occlusion,28 patients with complete portal vein occlusion complicated with spongiform degeneration,and 18 patients with complete portal vein occlusion complicated with acute superior mesenteric vein,SMV)thrombosis,and the patients were treated with intrahepatic portal via internal jugular vein.Results:In this treatment,the success rate of TIPS surgical technique was 82.0%(82/100),that of patients with partial portal vein occlusion was 100%(40/40),that of patients with complete portal vein occlusion was 71.43%(10/14),that of patients with complete portal vein occlusion and SMV thrombosis was 77.78%(14/18).The postoperative complications were 15.0%(6/40),28.57%(4/14),44.44%(8/18)and 42.86%(12/28)respectively.Conclusion In the TIPS treatment of patients with chronic portal vein thrombosis and esophageal variceal bleeding,the degree of slow vein obstruction can directly affect the success rate of treatment and the patency rate of shunt,so if patients do not have other effective treatment conditions,they can choose TIPS treatment.