CAJ | 학술논문

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,置入支架.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％ (71/831)、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.
목적 평개경경정맥간내문체정맥분류(TIPS)술적조작기술여위수술기안전성.방법 회고분석1126례접수TIPS술치료간경화문정맥고압자적림상자료.환자중남732례、녀394례,평균년령위46.4세.술전배제소화성궤양급기타가능인기출혈적질병,택기수술환자괄당조정기응혈공능화혈소판수량.천자경정맥,조영현시간정맥급하강정맥정황,천자문정맥병조영,전새곡장정맥,구낭확장분류통도,치입지가.술후여상규관찰병여항응치료화수방.계량자료비교행t검험.결과 TIPS술성공솔위98.6％(1110/1126),기중택기수술성공솔위98.8％(997/1009),급진수술성공솔위96.6％(113/117),평균문정맥압력유술전적(3.89±0.73) kPa강지술후적(2.61±0.63) kPa,차이유통계학의의(t=44.23,P＜0.05).경간정맥건립분류통도자957례,경간단하강정맥건립분류통도자130례,동일환자건립2개TIPS분류통도자23례.전새곡장정맥981례.145례련용경피간천자문정맥술혹련용위관상정맥전새술.총병사솔위0.6％(7/1110),기중택기수술병사솔위0.4％(4/997),급진수술병사솔위2.7％(3/113).엄중병발증발생솔위2.0％(22/1110),기중택기수술엄중병발증발생솔위1.8％(18/997),급진수술엄중병발증발생솔위3.5％(4/113).수방6、12、24개월시적증상복발솔분별위7.8％(65/831)、17.3％(132/763)、26.6％(175/657),분류도재협착솔분별위8.5％ (71/831)、23.5％(179/763)、32.0％(210/657),생존솔분별위98.0％ (814/831)、95.4％(728/763)、89.6％(589/657).결론 TIPS술전주호충분준비、술중근신조작、술후세치관찰병정병급시처리,가제고성공솔,강저풍험.
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％ (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.