CAJ | 학술논문

目的：探讨经颈内静脉肝内门腔静脉分流术（TIPSS ）治疗老年肝硬化门静脉高压症的疗效。方法2008年1月至2014年6月福建医科大学附属协和医院选取老年肝硬化门静脉高压症患者119例，均经内科治疗无效后择期行TIPSS治疗。术后随访24个月，观察记录患者手术前后的门静脉压力，以及术后3，6，12，24个月再出血发生情况、腹水治疗情况、分流道狭窄发生情况。手术前后门静脉压力比较采用配对 t检验，发生率的比较采用χ2检验。结果所有患者均成功置入支架建立分流道，其中75例采用Fluency覆膜支架，44例采用金属裸支架。患者TIPSS前后门静脉压力分别为（35.00±6.55）cmH2 O及（20.92±6.63） cmH2 O ，差异有统计学意义（ t＝13.43，P＜0.01）。术后3，6，12，24个月，36例顽固性腹水患者TIPSS后腹水完全缓解及部分缓解率分别为82.35％，84.85％，85.19％，76.00％；91例食管胃底静脉曲张破裂出血患者再出血发生率分别为5.49％，12.94％，22.72％，33.33％；119例患者分流道狭窄发生率分别为4.27％，10.00％，14.28％，24.19％。随访24个月，裸支架组狭窄率为47.73％，覆膜支架组狭窄率为17.33％，差异有统计学意义（χ2＝12.55，P＜0.01）。结论 TIPSS具有疗效好、创伤小、操作时间短、并发症少、肝功能损害轻等优点，是老年肝硬化门静脉高压症的有效治疗手段；术中应用覆膜支架可能会明显降低支架狭窄发生率。
목적：탐토경경내정맥간내문강정맥분류술（TIPSS ）치료노년간경화문정맥고압증적료효。방법2008년1월지2014년6월복건의과대학부속협화의원선취노년간경화문정맥고압증환자119례，균경내과치료무효후택기행TIPSS치료。술후수방24개월，관찰기록환자수술전후적문정맥압력，이급술후3，6，12，24개월재출혈발생정황、복수치료정황、분류도협착발생정황。수술전후문정맥압력비교채용배대 t검험，발생솔적비교채용χ2검험。결과소유환자균성공치입지가건립분류도，기중75례채용Fluency복막지가，44례채용금속라지가。환자TIPSS전후문정맥압력분별위（35.00±6.55）cmH2 O급（20.92±6.63） cmH2 O ，차이유통계학의의（ t＝13.43，P＜0.01）。술후3，6，12，24개월，36례완고성복수환자TIPSS후복수완전완해급부분완해솔분별위82.35％，84.85％，85.19％，76.00％；91례식관위저정맥곡장파렬출혈환자재출혈발생솔분별위5.49％，12.94％，22.72％，33.33％；119례환자분류도협착발생솔분별위4.27％，10.00％，14.28％，24.19％。수방24개월，라지가조협착솔위47.73％，복막지가조협착솔위17.33％，차이유통계학의의（χ2＝12.55，P＜0.01）。결론 TIPSS구유료효호、창상소、조작시간단、병발증소、간공능손해경등우점，시노년간경화문정맥고압증적유효치료수단；술중응용복막지가가능회명현강저지가협착발생솔。
Objective To evaluate the effect of transjuaular intrahepatic portosystemic stent shunt (TIPSS ) in the treatment of senile cirrhosis and portal hypertension. Methods A retrospective analysis was reviewed on the 119 elder patients with senile cirrhosis and esophageal varices bleeding and refractory ascites. All of them underwent TIPSS after medical treatment fails. They were strictly followed up for 2 years and their clinical data were analysed. Color doppler imaging and shunt angiography were used to follow up patients to analyze the cases and type of stenosis. Results All patients were successfully implanted with stents (75 cases with the fluency stents ,44 cases with bare metal stents)to establish shunt. Portal venous pressure from before TIPSS (35.00 ± 6.55 ) cmH2 O to after TIPSS (20.92 ± 6.63 ) cmH2 O ( t=13.43 , P<0.01 ). There is a significant difference. TIPSS after 3 months ,6 months ,12 months and 24 months ascites complete or partial remission rates were 82.35% ,84.85% ,85.19% and 76.00% ,rebleeding rates were 5.49% ,12.94% ,22.72%and 33.33% ,incidence of shunt stenosis were 4.27% ,10.00% ,14.28% and 24.19% . After 2 year follow up ,the bare stent group had 47.73% stenosis;the covered stent group had 17.33% (χ2=12.55 ,P<0.01 ). The difference between two groups was statistically significant. Conclusion TIPSS is available and satisfactory in the treatment of senile cirrhosis and portal hypertension , which has high efficacy. TIPSS is less invasive , takes shorter operation tim , causes fewer complications. Stenosis rate can be significantly decreased by the application of covered stent in TIPSS.