【摘要】 目的探讨经颈静脉肝内门体分流术(Tips)治疗肝硬化门高压症的疗效及并发症发生率,分析产生原因及处理方法.方法总结昆明医学院第二附属医院近4 a来行Tips治疗的126例患者资料,所有患者均采用Tips和胃冠状静脉及胃短静脉栓塞术,监测术前术后门静脉压力、门腔静脉压力梯度、血常规、凝血功能、肝肾功能、血氨,影像学及内镜检查.随访时间(2周～4 a),观察消化道出血,支架再堵,肝性脑病,肝衰竭等主要并发症的发生情况.结果 Tips技术成功率98.4%(124/126),门静脉压由术前(27.41±5.36)mmHg降为术后(20.04±4.32)mmHg,差异有统计学意义(P<0.01).23例活动性出血者行急诊Tips均成功止血,(即刻止血率达100%),顽固性腹水缓解率72%(91/126),肝性脑病28例,再发消化道出血22例,支架狭窄或闭塞20例,11例支架再次介入治疗,6例肝衰竭,16例死亡.结论 Tips联合胃冠状静脉及胃短静脉栓塞术,是治疗食道胃底静脉曲张出血快速有效安全的微创方法,合理的选择病人、精准放置支架、适度抗凝、定期复查能减少并发症提高中远期疗效、并为提供肝移植机会.更多还原

【Abstract】 Objective To discuss the curative effects,the incidence of complications,the reason and the management of transjugalar intrahepatic portosystemic shunt(Tips) in treatment of the patients with liver cirrhosis complicated with portal hypertension.Methods The data of 126 patients who received Tips treatment in recent 4 years in our hospital were summarized.All patients were performed Tipss and gastic vein occlusion.The portal venous pressure,portosystemic pressure gradients,haemogram,blood coagulation,hepatic and renal function,blood ammonia,imaging and endoscopy results were monitored before and after Tips treatment.All patients were followed up for 2 weeks to 4 years,and the incidence of complications such as alimentary tract hemorrhage,stent reocclusion,hepatic encephalopathy,hepatic failure were observed.Results The 98.4%(124/126) patients were succesful performed Tips treatment.The portal venous pressure decreasd from(27.41±5.36) mmhg pre-operation to(20.04 ±4.32) mmHg post-operation,and there was a statistic difference between pre-operation and post-operation(P<0.001).23 patients with acute gastic hemorrhoge were performed the emengent Tips treatment and the bleeding was successfully stopped(the instant hemostasis rate was 100%).The remission rate of reforactory ascites in 126 patients was 72%(91/126).There were 28 patients with hepatic encephalopathy,22 patients with re-heamomhage of gastic tract,20 patients with narrow or ocullusion in stent,6 patients with liver function failure and 16 cases of death.Conclusions The combination of Tips and gastic vein occlusion is a usefull and safe treatment for patients with esophagus and gastric hemorrhage.Selecting the suitable patients,settlement of the stents,anti-coagutation drugs may improve the curative effects,decrease the comptication,and save time for liver tansptantation.更多还原