Guo F F, Wu Z Y, Zhou P L, Han X W
Department of Pathology, Henan People's Hospital, Zhengzhou 450052, China.
Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Yi Xue Za Zhi. 2020 Feb 11;100(5):387-390. doi: 10.3760/cma.j.issn.0376-2491.2020.05.014.
To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS) for the treatment of patients with cavernous transformation of portal vein (CTPV) with vareceal bleeding. From September 2016 to June 2018, a total of 21 patients suffered CTPV complicated with vareceal bleeding were admitted to First Affiliated Hospital of Zhengzhou University. TIPS were performed combined with percutaneous transhepatic portal vein assist. There were 13 males and 8 females, with an average age of 27-67 (48±11) years. Blood routine examination, liver function test, blood ammonia and ultrasound Doppler were conducted 1,3,6 months after operation, and every 6 months during follow-up. Abdominal enhanced CT and digital substraction angiography were followed every year. TIPS were successfully performed in 19 cases (90.5%), esophageal and gastric varices were embolized in 17 cases; 2 cases failed to selective catheterized, then endoscopic therapy was performed.All bleeding stopped after operation. The pressure of portal vein decreased from 25.0-44.0 (33.7±5.4) mmHg (1 mmHg=0.133 kPa) to 17.0-30.0 (24.5±3.1) mmHg, portosystemic pressure gradient decreased from 16.0-32.0 (23.5±4.6) mmHg to 9.0-15.0 (11.4±1.9) mmHg after TIPS (all 0.05). During 3-24 months follow-up, 2 patients suffered from hepatic encephalopathy, 3 patients had recurrent upper gastrointestinal bleeding, including 1 duodenal ulcer and 2 esophageal varices. In-stent restenosis were found in 6 patients,in which 3 patients underwent shunt revision operation. At the end of the follow-up, the cumulative patency was 16/19. For patients with CTPV and vareceal bleeding, TIPS could reduce portal hypertension while embolizing varicose veins.It is a safe and effective treatment.
评估经颈静脉肝内门体分流术（TIPS）治疗门静脉海绵样变性（CTPV）合并静脉曲张出血患者的疗效及安全性。2016年9月至2018年6月，郑州大学第一附属医院共收治21例CTPV合并静脉曲张出血患者。行TIPS联合经皮肝门静脉穿刺辅助治疗。其中男13例，女8例，平均年龄27 - 67（48±11）岁。术后1、3、6个月及随访期间每6个月进行血常规、肝功能、血氨及超声多普勒检查。每年行腹部增强CT及数字减影血管造影检查。19例（90.5%）TIPS手术成功，17例食管及胃静脉曲张得到栓塞；2例未能成功选择性插管，改行内镜治疗。术后所有出血均停止。门静脉压力从25.0 - 44.0（33.7±5.4）mmHg（1 mmHg = 0.133 kPa）降至17.0 - 30.0（24.5±3.1）mmHg，TIPS术后门体压力梯度从16.0 - 32.0（23.5±4.6）mmHg降至9.0 - 15.0（11.4±1.9）mmHg（均P<0.05）。随访3 - 24个月，2例发生肝性脑病，3例再次发生上消化道出血，其中1例为十二指肠溃疡，2例为食管静脉曲张。6例发现支架内再狭窄，其中3例行分流术修正手术。随访结束时，累计通畅率为16/19。对于CTPV合并静脉曲张出血患者，TIPS可降低门静脉高压同时栓塞曲张静脉，是一种安全有效的治疗方法。
