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中华消化病与影像杂志(电子版) ›› 2021, Vol. 11 ›› Issue (01) : 31 -36. doi: 10.3877/cma.j.issn.2095-2015.2021.01.007

所属专题: 文献

临床研究

经颈静脉肝内门体分流术预防门静脉海绵样变食管胃底静脉曲张再出血的临床应用
金苏云1, 王广川2, 李赵鹏3, 黄广军2, 李翠1, 陈功海1, 张春清4,()   
  1. 1. 250021 济南,山东大学附属省立医院东院消化内科
    2. 250021 济南,山东第一医科大学附属省立医院东院消化内科
    3. 266000 山东省,青岛市市立医院微创介入治疗科
    4. 250021 济南,山东大学附属省立医院东院消化内科;250021 济南,山东第一医科大学附属省立医院东院消化内科
  • 收稿日期:2020-05-25 出版日期:2021-02-01
  • 通信作者: 张春清
  • 基金资助:
    国家自然科学基金(81370590); 山东省重点研发项目(2018GSF118100); 山东省重点研发项目(2017WS199); 济南市重点研发项目(2018050069)

Transjugular intrahepatic portosystemic shunt for the prevention of gastroesophageal variceal rebleeding in patients with cavernous transformation of portal vein

Sunyun Jin1, Guangchuan Wang2, Zhaopeng Li3, Guangjun Huang2, Cui Li1, Gonghai Chen1, Chunqing Zhang4,()   

  1. 1. Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, China
    2. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
    3. Department of minimally invasive interventional therapy, Qingdao Municipal Hospital, Qingdao 266000, China
    4. Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, China; Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
  • Received:2020-05-25 Published:2021-02-01
  • Corresponding author: Chunqing Zhang
  • About author:
    Corresponding author: Zhang Chunqing, Email:
引用本文:

金苏云, 王广川, 李赵鹏, 黄广军, 李翠, 陈功海, 张春清. 经颈静脉肝内门体分流术预防门静脉海绵样变食管胃底静脉曲张再出血的临床应用[J]. 中华消化病与影像杂志(电子版), 2021, 11(01): 31-36.

Sunyun Jin, Guangchuan Wang, Zhaopeng Li, Guangjun Huang, Cui Li, Gonghai Chen, Chunqing Zhang. Transjugular intrahepatic portosystemic shunt for the prevention of gastroesophageal variceal rebleeding in patients with cavernous transformation of portal vein[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2021, 11(01): 31-36.

目的

初步评估经颈静脉肝内门体分流术(TIPS)用于预防门静脉海绵样变(CTPV)患者食管静脉曲张再出血的可行性、有效性和安全性。

方法

选取2011年1月至2016年12月在山东省立医院住院,诊断为CTPV且合并食管静脉曲张出血史,行TIPS预防再出血的患者67例,纳入回顾性分析并随访。总结技术成功率、并发症发生率、再出血、支架通畅、肝性脑病及生存情况。

结果

在67例CTPV患者中,56例(83.6%)患者成功行TIPS术。单独通过颈静脉入路15例,经颈静脉联合经皮经肝入路33例,经颈静脉联合经皮经脾入路8例。TIPS术后平均门-体静脉压力梯度,从(28.09±7.28)mmHg降至(17.53±6.12)mmHg(P<0.01)。平均随访(23.91±12.35)个月,累计无出血率87.0%,支架通畅率81.5%,肝性脑性发生率27.8%,累计生存率88.9%。11例未成功行TIPS术的患者中死亡4例,再次出血4例。

结论

TIPS用于预防门静脉海绵样变性患者食管静脉曲张再出血,是一种安全、可行、有效的方法。

Objective

To evaluate the feasibility, efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS)in preventing gastroesophageal variceal rebleeding in patients with cavernous transformation of portal vein(CTPV).

Methods

A total of 67 patients who were diagnosed as CTPV and with a history of esophageal varices bleeding, and who underwent TIPS to prevent rebleeding from January 2011 to December 2016 in Shandong Provincial Hospital were selected for retrospective analysis and follow-up.The technical success rate, complication rate, rebleeding, stent patency, hepatic encephalopathy and survival were summarized.

Results

TIPS was successfully performed in 56(83.6%)of the 67 CTPV patients.There were 15 cases via a transjugular approach alone, 33 cases via a combined transjugular/transhepatic approach, and 8 cases via a combined transjugular/transsplenic approach.After TIPS the mean portosystemic pressure gradient(PSG)decreased from(28.09±7.28)mmHg to(17.53±6.12)mmHg(P<0.01). The mean follow-up was(23.91±12.35)months.The cumulative non-bleeding rate was 87.0%, the stent patency rate was 81.5%, the hepatic encephalopathy incidence was 27.8%, and the cumulative survival rate was 88.9%.Among the 11 patients who did not receive TIPS successfully, 4 died and 4 rehemorrhaged.

Conclusion

TIPS is a safe, feasible and effective method for preventing gastroesophageal variceal rebleeding in patients with CTPV.

表1 67例患者的基本资料
图1 患者,女性,26岁,经皮经肝引导穿刺行TIPS。1A超声引导下PTCD针经皮穿刺(黑箭)门静脉左支(白箭);1B经皮经肝(黑箭)门静脉造影示门静脉主干血栓,并海绵样变(白箭);1C RUPS-100经肝静脉穿刺门静脉后,直接门静脉造影示门静脉主干闭塞,肝门处可见大量侧支静脉;1D TIPS后的门静脉造影示支架通畅,长箭是覆膜支架,短箭示裸支架
图2 患者,男性,54岁。经皮经脾辅助引导穿刺行TIPS。2A经皮经脾(黑箭)门静脉造影显示门静脉主干闭塞,周边肝内侧支静脉形成;2B导管于门静脉内标记,RUPS-100经肝静脉穿刺门静脉,箭示穿刺针;2C直接门静脉造影显示门静脉主干完全闭塞,可见胃左静脉供应食管胃底静脉曲张;2D TIPS后的门静脉造影显示支架通畅,胃左静脉内应用弹簧圈及组织胶栓塞后,血流消失
图6 TIPS成功组和失败组的未再出血率
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