摘要
目的评价经颈静脉肝内门体静脉分流（TIPS）术的操作技术与围手术期安全性。方法回顾分析1126例接受TIPS术治疗肝硬化门静脉高压者的临床资料。患者中男732例、女394例，平均年龄为46．4岁。术前排除消化性溃疡及其他可能引起出血的疾病，择期手术患者适当调整其凝血功能和血小板数量。穿刺颈静脉，造影显示肝静脉及下腔静脉情况，穿刺门静脉并造影，栓塞曲张静脉，球囊扩张分流通道，置人支架。术后予常规观察并予抗凝治疗和随访。计量资料比较行t检验。结果TIPS术成功率为98．6％（1110／1126），其中择期手术成功率为98．8％（997／1009），急诊手术成功率为96．6％（113／117），平均门静脉压力由术前的（3．89±0．73）kPa降至术后的（2．61±0．63）kPa，差异有统计学意义（t=44．23，P〈0．05）。经肝静脉建立分流通道者957例，经肝段下腔静脉建立分流通道者130例，同一患者建立2个TIPS分流通道者23例。栓塞曲张静脉981例。145例联用经皮肝穿刺门静脉术或联用胃冠状静脉栓塞术。总病死率为0．6％（7／1110），其中择期手术病死率为0．4％（4／997），急诊手术病死率为2．7％（3／113）。严重并发症发生率为2．0％（22／1110），其中择期手术严重并发症发生率为1．8％（18／997），急诊手术严重并发症发生率为3．5％（4／113）。随访6、12、24个月时的症状复发率分别为7．8％（65／831）、17．3％（132／763）、26．6％（175／657），分流道再狭窄率分别为8．5％（71／8311）、23．5％（179／763）、32．0％（210／657），生存率分别为98．0％（814／831）、95．4％（728／763）、89．6％（589／657）。结论TIPS术前做好充分准备、术中谨慎操作、术后细致观察病情并及时处理，可提高成功率，降低风险。
Objective To evaluate the technique and perioperative safety of transjugular intrahepatic porto systemic shunt （TIPS）. Methods The clinical data of 1126 liver cirrhosis and portal hypertension patients received TIPS treatment were retrospectively analyzed. Among all the patients, male 732 cases, female 394 cases, the mean age was 46. 4 years. The jugular vein was punctured and the condition of hepatic vein and the inferior vena cava was showed by angiography. The portal vein was punctured and angiographied, varices veins were embolized. The tract was dilated by the balloon and stent was set. After treatment, regular observation, anticoagulant therapy and follow- up were carried out. Comparison t test was performed for measurement data. Results The over all successful rate of TIPS was 98. 6% （1110/1126）, in which the successful rate of elective operation was 98.8% （997/1009） and the successful rate of emergency operation was 96.6% （113/117）. The average portal vein pressure decreased from （3.89±0.73） kPa before operation to （2.61±0.63） kPa after operation, and the difference was statistically significant （t=44.23, P〈0.05）. The tracts was created in 957 cases through hepatic vein, 130 cases through inferior vena cava,and 23 cases with two TIPS tracts. Varices veins were embolized in 981 cases. A total of 145 cases had combined percutaneous transhepatic portography. The overall mortality rate was 0.6 % （7/1110）, in which the mortality rate of elective operation was 0.4% （4/997） and the mortality rate of emergency operation was 2. 7% （3/113）. The severe complication rate was 2. 0% （22/1110）, of elective operation accounted for 1.8% （18/1009） and emergency operation accounted for 3. 5% （4/113）. After six-month,12 month and 24-month follow up, the recurrence rate was 7.8% （65/831）, 17.3% （132/ 763） and 26.6,0/oo （175/657）;restenosis rate was 8. 5% （71/831）, 23. 5% （179/763） and 32. 0% （210/657） ;and the survival rate was 98.0% （814/831）, 95.4% （728/763） and 89.6% （589/657）. Conclusion The successful rate of TIPS can be increased and the risk reduced by full preparation before operation, careful manipulation during operation, meticulous observation and timely treatment after operation.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2013年第5期331-335,共5页
Chinese Journal of Digestion
关键词
肝硬化
高血压
门静脉
门体分流术
外科
围手术期医护
Liver cirrhosis
Hypertension, portal
Portasystemic shunt, surgical
Perioperative care
