【摘要】 笔者报告了自１９９２年６月以来，应用ＴＩＰＳＳ治疗６２例肝硬化门脉高压（ＣＰＨ）的研究结果。６２例中，肝炎后ＣＰＨ３３例；酒精性ＣＰＨ３例；Ｂｕｄｄ－Ｃｈｉａｒｉ综合征（ＢＣＳ）４例，其余为原因不明者。在ＴＩＰＳＳ获得成功的６０例（９７％）中，应用国产Ｚ－ｓｔｅｎｔ者４６例。其中，并用食管胃底静脉硬化栓塞术（８ＥＥＶ）者３１例。ＴＩＰＳＳ后，门脉压平均下降１．３２±０．５１ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ＿２Ｏ）。病人的主要症状、体征得到有效控制或／和明显改善。未发生与技术操作有关的严重并发症。但出现肝性脑病者８例（１４％），术后经１～２５个月（平均９个月）的随访观察，肝内分流道发生阻塞者９例（１５％），７例获得再通。术后１～２０个月内死亡１０例。其中，３０天内死亡４例。笔者认为：（１）ＴＩＰＳＳ作为ＣＰＨ治疗的一个安全有效的新方法，既可作为应急性抢救措施，也可作为预防性治疗手段；其治疗对象既可以是酒精性ＣＰＨ，也可以是肝炎后ＣＰＨ及ＢＣＳ所致的瘀血性ＣＰＨ；（２）在实施限制性ＴＩＰＳＳ时，应把ＳＥＥＶ作为一个重要步骤。（３）与一般Ｚ－ｓｔｅｎｔ相比，螺旋式Ｚ－ｓｔｅｎｔ更适于在ＴＩＰＳＳ中应用。更多还原

【Abstract】 The results of study on treatment of 62 cases of cirrhotic portal hypertension（CPH）by transjugular intrahepatic portosystemic stent shunt（TIPS）from Jun 1992 to Jun 1994 were reported,among them, 33 cases were posthepatitis CPH,3 alcoholic,4 Budd-Chiari sydrome（BCS）,and the others of unknown tliology.TIPSS was successful in 60 cases（97%）,homemade Z stent was used in 46 cases.TIPSS with sclerotic embolization of esophagogastric varices（SEEV）was done in 31 cases.The mean portal pressure drop was 1. 32±0.5lkPa （1kPa=10.20cmH₂O）,the main symptoms and signs were controlled effectivly or improved markedly. There were no complica- tions related to the procedure,but hepatic encephalopathy occurred in 8 cases（13.3%）during a fol- low-up period of 1-25 months（mean 9 months）.Shunt tract obstruction occurred in 9 cases（15%）, 7 of them were zecanalized.10 cases died 1-20 months after procedure,4 of them died within 30 days. The authors considered that:（ 1）Being a safe and effective therapeutic method,TIPSS can be used not only to treat alcoholic,posthepatitis or BCS CPH,but also as an emergent or prophylactive measure.（2）SEEV should be used in partial shunt with TIPSS as an important ad- junctive treatment.（3）Spiral Z stent is more suitable for TIPSS than Z stent.更多还原