CAJ | 학술논문

目的：探讨经皮经肝穿刺测量门静脉压力来评估曲张的食管胃底静脉发生出血风险的可行性及判断出血风险的门静脉压力参考值、是否行预防性经颈内静脉肝内门体分流术(TIPSS)的门静脉压力参考值。方法临床确诊的40例乙肝后肝硬化致食管胃底静脉曲张自发性出血患者在行 TIPSS 及经皮经肝食管胃底静脉曲张栓塞术中测量门静脉的压力；对临床确诊的40例乙肝后肝硬化致食管胃底静脉曲张未发生出血的患者在行预防性 TIPSS 及经皮经肝穿刺测量门静脉压力；对2组间的门静脉的压力进行比较。结果肝硬化门脉高压症出血组门静脉压力为(41.97±5.12)cmH 2 O,未出血组压力为(33.44±7.79)cmH 2 O,2组间差异有统计学意义(P <0.001)；门静脉压力>37.45 cmH 2 O 可作为行预防性 TIPSS 的参考依据之一。结论通过经皮经肝穿刺测量门静脉的压力,可评估乙肝后肝硬化食管胃底静脉曲张发生出血的风险,通过经皮经肝穿刺门静脉压力测量可作为是否对乙肝后肝硬化食管胃底静脉曲张尚未发生出血的患者行预防性 TIPSS 的参考依据。
목적：탐토경피경간천자측량문정맥압력래평고곡장적식관위저정맥발생출혈풍험적가행성급판단출혈풍험적문정맥압력삼고치、시부행예방성경경내정맥간내문체분류술(TIPSS)적문정맥압력삼고치。방법림상학진적40례을간후간경화치식관위저정맥곡장자발성출혈환자재행 TIPSS 급경피경간식관위저정맥곡장전새술중측량문정맥적압력；대림상학진적40례을간후간경화치식관위저정맥곡장미발생출혈적환자재행예방성 TIPSS 급경피경간천자측량문정맥압력；대2조간적문정맥적압력진행비교。결과간경화문맥고압증출혈조문정맥압력위(41.97±5.12)cmH 2 O,미출혈조압력위(33.44±7.79)cmH 2 O,2조간차이유통계학의의(P <0.001)；문정맥압력>37.45 cmH 2 O 가작위행예방성 TIPSS 적삼고의거지일。결론통과경피경간천자측량문정맥적압력,가평고을간후간경화식관위저정맥곡장발생출혈적풍험,통과경피경간천자문정맥압력측량가작위시부대을간후간경화식관위저정맥곡장상미발생출혈적환자행예방성 TIPSS 적삼고의거。
Objective To evaluate the feasibility of percutaneous transhepatic portal vein pressure measurement for assessment of the risk of esophagogastric variceal bleeding in order to provide a reference for preventive transjugular vein intrahepatic portal-sys-temical shunt (TIPSS).Methods Portal vein pressure in 40 patients with hepatitis B cirrhosis complicated by esophagogastric variceal bleeding was measured during the TIPSS and percutaneous transhepatic esophagogastric varices embolization,and it was also done in other similar 40 patients without variceal bleeding,The pressures between the two groups were compared.Results The por-tal vein pressure in patients with or without bleeding was (41.97±5.12)cmH 2 O or (33.44±7.79)cmH 2 O,exhibiting a significant difference (P <0.001).The portal vein pressure more than 37.45cm H 2 O was regarded as the reference of preventive TIPSS.Con-clusion The measurement of portal vein pressure by percutaneous transhepatic portal vein puncture is feasible for evaluation of bleeding risk in patients with esophagogastric varices,and this provides a reference for preventive TIPSS in treatment of liver crrhosis with esophagogastric varices.