Mingoli A, Modini C, Salvatori F, Bezzi M, Sgarzini G, Nardacchione F, Marzano M
I Clinica Chirurgica, Università La Sapienza, Roma, Italy.
Ital J Gastroenterol. 1995 Jul-Aug;27(6):309-12.
Variceal hemorrhage is a leading cause of death in patients with hepatic cirrhosis. We report the case of two cirrhotic patients with hepatocarcinoma in whom oesophageal varices bled repeatedly. Because the bleeding was not controlled by sclerotherapy, vasopressin or Blakemore balloon, the patients were evaluated for emergency transjugular intrahepatic portosystemic shunt. After the procedure, portal vein pressure decreased from 45.5 mmHg to 18 mmHg and from 44 mmHg to 19 mmHg respectively and no filling of varices was evident at venogram or endoscopy. After 16 and 8 months respectively, bleeding had not recurred, and no episodes of encephalopathy were referred. Transjugular intrahepatic portosystemic shunt should always be considered an effective emergency therapeutic alternative to shunt surgery in patients with active variceal bleeding when traditional management fails.
静脉曲张破裂出血是肝硬化患者的主要死因。我们报告了两例肝硬化合并肝癌患者的病例，这两名患者的食管静脉曲张反复出血。由于硬化疗法、血管加压素或Blakemore气囊均无法控制出血，因此对患者进行了紧急经颈静脉肝内门体分流术评估。术后，门静脉压力分别从45.5 mmHg降至18 mmHg，从44 mmHg降至19 mmHg，静脉造影或内镜检查均未发现静脉曲张充盈。分别在16个月和8个月后，出血未再复发，也未出现肝性脑病发作。当传统治疗方法无效时，经颈静脉肝内门体分流术应始终被视为活动性静脉曲张出血患者分流手术的一种有效的紧急治疗替代方法。
