CAJ | 학술논문

目的评估经颈内静脉肝内门体分流术( TIPS)联合胃冠状静脉栓塞术治疗食管胃底静脉曲张的疗效.方法对2005年7月至2011年3月山东大学附属省立医院36例肝硬化食管胃底静脉曲张患者行TIPS联合胃冠状静脉栓塞术治疗,术后7d复查腹部超声及肝功能、血常规等检查,术后1个月复查胃镜观察患者食管胃底静脉曲张变化情况,并随访3～6个月观察再出血及并发症的发生情况.结果 TIPS联合胃冠状静脉栓塞术的技术成功率为100％,术前门静脉主干压力为:(28 ±8)mm Hg(1 mm Hg=0.133 kPa),术后下降至(14±7) mm Hg.造影见食管胃底曲张静脉消失,术后患者肝功明显改善,食管胃底静脉曲张程度明显减轻.术前Child-Pugh分级A级21例,B级11例,C级4例,术后3个月Child-Pugh分级A级29例,B级5,C级2例.患者腹水明显减轻甚至消失；脾功能亢进亦得到明显改善,表现为术后脾脏缩小,血小板数目由术前(45±20)×109/L增加至(59±15)×109/L.随访3～6个月,其中4例患者术后出现肝性脑病,经治疗后缓解,1例患者术后出现分流道狭窄,再次置入支架后狭窄再通.半年内无食管胃底静脉曲张破裂出血发生.结论 TIPS联合胃冠状静脉栓塞术能有效降低门静脉压,控制并预防食管胃底静脉曲张破裂出血,手术成功率高、并发症少,术后复发率低,具有重要的临床应用价值.
목적 평고경경내정맥간내문체분류술( TIPS)연합위관상정맥전새술치료식관위저정맥곡장적료효.방법 대2005년7월지2011년3월산동대학부속성립의원36례간경화식관위저정맥곡장환자행TIPS연합위관상정맥전새술치료,술후7d복사복부초성급간공능、혈상규등검사,술후1개월복사위경관찰환자식관위저정맥곡장변화정황,병수방3～6개월관찰재출혈급병발증적발생정황.결과 TIPS연합위관상정맥전새술적기술성공솔위100％,술전문정맥주간압력위:(28 ±8)mm Hg(1 mm Hg=0.133 kPa),술후하강지(14±7) mm Hg.조영견식관위저곡장정맥소실,술후환자간공명현개선,식관위저정맥곡장정도명현감경.술전Child-Pugh분급A급21례,B급11례,C급4례,술후3개월Child-Pugh분급A급29례,B급5,C급2례.환자복수명현감경심지소실；비공능항진역득도명현개선,표현위술후비장축소,혈소판수목유술전(45±20)×109/L증가지(59±15)×109/L.수방3～6개월,기중4례환자술후출현간성뇌병,경치료후완해,1례환자술후출현분류도협착,재차치입지가후협착재통.반년내무식관위저정맥곡장파렬출혈발생.결론 TIPS연합위관상정맥전새술능유효강저문정맥압,공제병예방식관위저정맥곡장파렬출혈,수술성공솔고、병발증소,술후복발솔저,구유중요적림상응용개치.
Objective To evaluate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) plus embolotherapy in the treatment of patients with gastroesophageal varices.Methods A total of 36 patients with gastroesophageal varices underwent the therapies of TIPS plus embolotherapy from July 2005 to March 2011 at Provincial Hospital Affiliated to Shandong University.The rechecked items included abdominal ultrasound examination,liver function test and blood routine examination at Day 7 post-operation.All received endoscopic examinations at Month 1.Results The technical success rate of TIPS plus embolotherapy was 100％.The portal vein pressures declined from (28 ± 8) mm Hg( 1 mm Hg =0.133 kPa)to (14 ± 7 ) mm Hg at post-operation. Angiography showed gastroesophageal varices disappeared in all patients.Both liver function and gastroesophageal varices markedly improved.During the follow-up period of 3 -6 months,4 cases had hepatic encephalopathy and 1 case stent restenosis at post-operation.And most cases were resolved after treatment. No rebleeding occurred during the follow-up period.Conclusions The combined modality of TIPS plus embolotherapy can effectively lower portal vein pressure and cure esophageal and gastric varice bleeding. As a safe and excellent interventional procedure with fewer complications and a lower recurrence rate of portal hypertension,it has great clinical values in the treatment of portal hypertension and gastroesophageal varices.