经颈静脉肝内门体分流术（TIPS）联合奇静脉断流术改善了门静脉高压症患者的长期临床疗效。
Combined TIPS with portal-azygous disconnection improved the long term clinical outcome in portal hypertension patients.
作者信息
Wu Xingjiang, Han Jianmin, Cao Jianmin, Wu Xuehao, Li Weisu, Sun Jinmei, Li Jieshou
机构信息
Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, 210002 Nanjing, Jiangsu, China.
出版信息
J Hepatobiliary Pancreat Surg. 2009;16(6):858-64. doi: 10.1007/s00534-009-0189-0.
OBJECTIVE
The results of TIPS and the combined TIPS and portal-azygous disconnection for portal hypertension and variceal bleeding were evaluated.
METHODS
358 patients with portal hypertension were admitted to our clinical ward because of variceal bleeding. 263 patients underwent TIPS and 95 patients with combined TIPS and portal-azygous disconnection. Portal hemodynamics was evaluated by pressure measurements, venography and Doppler ultrasound before and 2 weeks after the procedure. The rates of shunt patency, rebleeding, encephalopathy and survival were observed during the follow-up period from 1 to 10 years.
RESULTS
The portal pressure and HVPG were decreased significantly after TIPS. TIPS procedure was successfully performed in 97.50% patients. During 1 month after treatment, acute shunt occlusion occurred in 3.42% patients with TIPS and there were no occluded shunts in patients with combined TIPS and portal-azygous disconnection. Encephalopathy was observed in 36.50% patients with TIPS and 18.95% with combined TIPS and portal-azygous disconnection. Recurrent variceal bleeding was documented in 6.46% patients with TIPS and none of patients with combined TIPS and azygous portal disconnection. Thirty-three patients with TIPS and two patients with combined TIPS and portal-azygous disconnection died. During follow-up periods, the patency of shunts in patients with TIPS and patients combined TIPS and azygous portal disconnection was 68.47, 43.84 and 87.06, 57.65% in 12 and 24 months after operation, respectively. The rates of rebleeding, and encephalopathy in patients with TIPS and patients with combined TIPS and azygous portal disconnection were 17.95, 31.79 and 7.04, 16.47%, respectively. The survival rate in 1, 5, 10 years in patients with TIPS and patients combined TIPS and azygous portal disconnection was 87.68, 51.23, 39.90 and 94.12, 81.18, 76.47%.
CONCLUSION
Combined TIPS and portal-azygous disconnection can improve the effect of TIPS for portal hypertension.
目的
评估经颈静脉肝内门体分流术（TIPS）以及TIPS联合门奇静脉断流术治疗门静脉高压症和静脉曲张破裂出血的效果。
方法
358例因静脉曲张破裂出血而入住我院临床病房的门静脉高压症患者。263例行TIPS，95例行TIPS联合门奇静脉断流术。术前及术后2周通过压力测量、静脉造影和多普勒超声评估门静脉血流动力学。在1至10年的随访期内观察分流道通畅率、再出血率、肝性脑病发生率及生存率。
结果
TIPS术后门静脉压力和肝静脉压力梯度（HVPG）显著降低。97.50%的患者TIPS手术成功。治疗后1个月内，TIPS患者急性分流道闭塞发生率为3.42%，TIPS联合门奇静脉断流术患者无分流道闭塞。TIPS患者肝性脑病发生率为36.50%，TIPS联合门奇静脉断流术患者为18.95%。TIPS患者复发性静脉曲张破裂出血发生率为6.46%，TIPS联合门奇静脉断流术患者无复发性出血。33例TIPS患者和2例TIPS联合门奇静脉断流术患者死亡。随访期间，TIPS患者及TIPS联合门奇静脉断流术患者术后12个月和24个月分流道通畅率分别为68.47%、43.84%和87.06%、57.65%。TIPS患者及TIPS联合门奇静脉断流术患者再出血率分别为17.95%、31.79%，肝性脑病发生率分别为7.04%、16.47%。TIPS患者及TIPS联合门奇静脉断流术患者1年、5年、10年生存率分别为87.68%、51.23%、39.90%和94.12%、81.18%、76.47%。
结论
TIPS联合门奇静脉断流术可提高TIPS治疗门静脉高压症的疗效。
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