溶栓治疗TIPS通道闭塞一例

溶栓治疗ＴＩＰＳ通道闭塞一例王建华程洁敏程新宝杨帆患者男，４９岁。因肝硬化、门脉高压和食管静脉曲张破裂大出血，１９９３年行经颈静脉肝内门腔静脉分流术（ＴＩＰＳ）治疗。１９９５年２月１４日再次发生食管静图１门静脉造影见ＴＩＰＳ通道完全闭塞，门脉主干及分...     

肝内门体内支架分流术与部分脾栓塞术对肝硬化门脉高压症疗效的比较

肝内门体内支架分流术与部分脾栓塞术对肝硬化门脉高压症疗效的比较３１００１３杭州解放军第１１７医院马炬明陈达伟陆雪华盛玉才吴锦章施红余秀华朱松英关键词高血压，门静脉；肝硬化中国图书资料分类号Ｒ５７５．２１经颈静脉肝内门体内支架分流术（ＴＩＰＳＳ）与部分...     

经颈静脉肝内门体分流术易发生的并发症分析

经颈静脉肝内门体分流术易发生的并发症分析崔进国，冯艳娇，张书田，陈富永，田贵琴，张戌周经颈静脉肝内门体分流术（ｔｒａｎｓｊｕｇｕｌａｒｉｎｔｒａｈｅｐａｔｉｃｐｏｒｔｏｓｙｓｔｅｍｉｃｓｔｅｎｔｓｈｕｎｔ，ＴＩＰＳＳ）近２年来在国内已推广应用，由于Ｔ...     

经颈静脉肝内门体内支架分流术中经下腔静脉直接穿刺门静…

目的：通过观察肝门部门静脉、肝实质与肝后段下腔静脉之间的解剖关系，探讨经颈静脉肝内门体内支架分流术（ＴＩＰＳＳ）中经下腔静脉直接穿刺门静脉分支的可行性。材料与方法：观察１０例新鲜人体尸检正常肝脏标本的肝后段下腔静脉与肝脏以及门静脉分岐部、门静脉左右主支与肝脏和肝后段下腔静脉间的解剖关系，并对１０％福尔马林固定后的标本做光镜下观察。结果：１０例标本中，肝后段下腔静脉的一部分通过肝尾状叶与门静脉分歧部     

经颈静脉肝内门腔静脉内支架分流术的研究近况

经颈静脉肝内门腔静脉内支架分流术的研究近况王茂强，张金山自１９９０年德国学者Ｒｉｃｈｔｅｒ正式报道首组经颈静脉肝内门腔静脉内支架分流术（ＴＩＰＳＳ）病例以来，不少国家相继开展了这一技术，经过近几年的临床应用和改进，积累了一些经验。笔者拟对ＴＩＰＳＳ的...     

经颈静脉肝内门体分流术的相关解剖

熟悉颈静脉解剖和穿刺，肝脏，肝静脉和门静脉的解剖与变异，是成功地进行颈静脉肝内门体分流术的前提，本介绍了有关上述诸方面的基本知识。     

TIPSS操作及有关技术探讨

ＴＩＰＳＳ操作及有关技术探讨崔志鹏，邢冲冲，张金山，王茂强，杨立，于淼经颈静脉肝内门腔静脉内支架分流术（ｔｒａｎｓｊｕｇｕ－ｌａｒｉｎｔｒａｈｅｐａｔｉｃｐｏｒｔｏｓｙｓｔｅｍｉｃｓｔｔ１ｎｔｓｈｕｎｔ，简称ＴＩＰＳＳ）是一项治疗门脉高压症的新技术，...     

经左颈内静脉入路肝内门腔静脉支架分流术（附12例报告）

常规的经颈静脉肝内门腔支架分流术均经右颈内静脉入路。这种入路操作容易，已成为经典途径。本文报告了114例肝硬化门脉高压患者中12例经左颈静脉入路完成Tipss操作。12例患者在造影时发现右颈静脉血栓形成、狭窄甚至闭塞。在右颈内静脉闭塞的情况下，经左侧入路是可行的。     

TIPS治疗难治性食管静脉曲张破裂出血10例体会

本文报道１０例经颈静脉、肝内门腔静脉分流术（ＴＩＰＳ）治疗难治性食道静脉破裂出血的体会，并对其中期结果及影响因素、ＴＩＰＳ和其它治疗方法的效果比较作一初步分析。１材料与方法１．１男性８例、女性２例，年龄３２～５６岁，平均４８岁。均为复发性出血者，出血...     

经颈静脉途径肝内门体分流术并发急性心包填塞一例

经颈静脉途径肝内门体分流术并发急性心包填塞一例张金山，王茂强，杨立，邢冲冲经颈静脉途径肝内门体分流术（ＴＩＰＳ）是近年应用于临床治疗门脉高压症的新技术，一般认为其安全性高，极少数可并发肝脏、胆道损伤及腹内出血，并发心脏损伤、心包填塞者罕见，我们遇见Ｌ...     

Morphologic and clinical results of the transjugular intrahepatic portosystemic stent-shunt (TIPSS)

The concept of transjugular intrahepatic portosystemic stent-assisted shunt (TIPSS) using the Palmaz iliac stent has been successfully accomplished in 18 of 24 patients representing a technical success rate of 75%. Fourteen were male, 4 female with a mean age of 60 years (range 34–84 years). According to classification of Child’s and Turcotte, 6 were in stage A, 6 in stage B, and 6 in stage C. Five patients were treated on an emergency basis because of massive active bleeding. In 10 patients the portosystemic tract was created between the middle hepatic vein and the right main stem of the portal vein in 8, and the left main stem in 2 patients. In 8 patients, the shunt was established between the right hepatic vein and the right main branch of the portal vein. The portosystemic gradient in 18 patients was 29.9±6 mm Hg and dropped to an average of 16.9±4 mm Hg after shunt establishment. Within the early postprocedural period of 30 days, 1 patient died of direct complications of the procedure. Because of catheter dislocation, embolization of the percutaneous transhepatic approach to the portal vein after successful shunt “creation” could not be done and was followed by intraabdominal exsanguination. One patient died of an ARDS after TIPSS. A third developed pulmonary infection. In 13 patients, because of hematomas at the puncture site of the transhepatic approach, only the transjugular approach was elected for establishing TIPSS. The mean portosystemic gradient in 18 patients prior to TIPSS was 29±6 mm Hg (range 19–41 mm Hg), dropped to an average of 16.9±4 mm Hg (range 7–21 mm Hg), and showed no significant change 6 months after TIPSS with a pressure of 16±1.8 mm Hg. The 1-year survival rate was 75% (8/12); the 2-year rate was 50% (3/6).     

Technical challenges in TIPS creation via the right subclavian vein

This report describes a 64-year-old man with Laennec cirrhosis requiring a transjugular intrahepatic portosystemic shunt (TIPS) to alleviate ascites before surgical mesh repair of a large symptomatic umbilical hernia. During the procedure, both internal jugular veins and the right external jugular vein were found to be occluded. The right subclavian vein was accessed and a TIPS was successfully created. Some of the technical challenges encountered in performing the procedure from the right subclavian vein are described.     

Endovascular treatment of a portal vein tear during TIPSS

During a transjugular portosystemic stent-shunt (TIPSS) procedure a portal vein laceration occurred with subsequent intraperitoneal hemorrhage. A PTFE-covered nitinol stent was successfully placed eliminating the leak and creating a functioning portosystemic shunt. This case demonstrates both the importance of portal vein puncture more than 1 cm from the bifurcation and the necessity of maintaining a stock of available stent-grafts.     

Percutaneous transjugular intrahepatic portosystemic shunt (TIPS). The preliminary experience and proposal of a new method]

A new interventional procedure employing metallic stents has been recently suggested to perform percutaneous portosystemic shunts in the treatment of variceal bleeding in portal hypertension; the technique is called TIPSS (transjugular intrahepatic portosystemic stent shunt). This percutaneous treatment presents several advantages over surgery: the shunt diameter can be calibrated according to the degree of portal hypertension; moreover, TIPSS can be performed in patients waiting for liver transplantation because it does not alter the vascular anatomy of liver. The original technique employed transhepatic portography. In this paper the authors report on their personal experience and present their series of 4 patients with portal hypertension and variceal bleeding, in whom TIPSS was performed utilizing noninvasive US guidance. Variceal bleeding was successfully treated in all patients and variceal distension was also obtained.     

Pull-Through Technique for Recanalization of Occluded Portosystemic Shunts (TIPS): Technical Note and Review of the Literature

Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction is an important problem after creation of shunts. Most commonly, TIPS recanalization is performed via the jugular vein approach. Occasionally it is difficult to cross the occlusion. We describe a hybrid technique for TIPS revision via a direct transhepatic access combined with a transjugular approach. In two cases, bare metal stents or polytetrafluoroethylene (PTFE)-covered stent grafts had been placed in TIPS tract previously, and they were completely obstructed. The tracts were inaccessible via the jugular vein route alone. In each case, after fluoroscopy or computed tomography-guided transhepatic puncture of the stented segment of the TIPS, a wire was threaded through the shunt and snared into the right jugular vein. The TIPS was revised by balloon angioplasty and additional in-stent placement of PTFE-covered stent grafts. The patients were discharged without any complications. Doppler sonography 6 weeks after TIPS revision confirmed patency in the TIPS tract and the disappearance of ascites. We conclude that this technique is feasible and useful, even in patients with previous PTFE-covered stent graft placement.     

Successful transfemoral creation of an intrahepatic portosystemic shunt with use of the Viatorr device

Although the large majority of cases are anatomically favorable and therefore technically feasible, congenital or acquired conditions may complicate or even preclude successful creation of a transjugular intrahepatic portosystemic shunt (TIPS). The present report describes the use of the inferior right hepatic vein from a femoral vein access to obtain portal access and place a covered stent, reconstruct a partially occluded portal vein, and embolize large gastric varices in a patient with a persistent left superior vena cava (SVC) and absent right SVC.     

Technical advances in transjugular intrahepatic portosystemic shunts.

A transjugular intrahepatic portosystemic shunt (TIPS) can be created percutaneously with the Palmaz balloon-expandable stent. This article describes a transjugular-only approach with a 16-gauge needle. A functional and efficacious shunt can be achieved in most cases with stent diameters of 8-10 mm. Occasionally, a 12-mm-diameter shunt is necessary for effective variceal decompression. The procedure is considered successful when the portosystemic gradient is lowered to 12 mm Hg or less after stent placement. Hepatic vein stenosis in the shunt outflow can develop after the TIPs procedure. This complication has been treated successfully with additional stent placement. TIPS can undoubtedly be performed successfully and safely with a transjugular-only approach; however, the full impact of TIPS on the treatment of portal hypertension remains to be determined.     

门脉充血指数的动态观察判定TIPSS支架管功能的价值

目的　探讨通过测定经颈静脉肝内门体分流 (TIPSS)手术前后门脉充血指数 (CI)的变化以判定支架管功能的价值。方法　测定并分析比较支架管功能正常组和支架管功能障碍 (狭窄或闭塞 )组TIPSS手术前后CI的演变情况。结果　术前支架管功能正常组和支架管功能障碍组CI无明显差异 (P >0 .0 5 ) ,术后 1周两组CI均较术前明显下降 (P <0 .0 1) ,但组间比较差异不显著 (P >0 .0 5 )。功能正常组术后各时相点 (1周、1月、3月、6月、12月、18月、2 4月 )之间CI均无明显差异 (P >0 .0 5 ) ,但均与术前差异显著 (P <0 .0 1)。而功能障碍组在出现狭窄或闭塞前各时相点 (1周、1月、3月 )之间所测CI也无差异 (P >0 .0 5 ) ,当出现狭窄、闭塞时 ,CI均较前各时相点显著升高 (P<0 .0 1)。结论　TIPSS手术前后CI的波动间接反映了支架管功能演变情况 ,动态观察CI变化可作为超声直接显像支架管评估其功能的方法的重要补充。若当超声直接显像支架管困难时 ,对CI的测定价值更大     

Ultrasonography-guided percutaneous transhepatic portacaval shunt creation

We successfully created a percutaneous transhepatic portacaval shunt under ultrasonography (US) guidance in a 46-year-old man with refractory ascites. The shunt was created to salvage an attempt to create a transjugular intrahepatic portosystemic shunt (TIPS) that failed because of the elevated level of portal vein bifurcation due to alcoholic liver cirrhosis. Under US guidance, we simultaneously punctured the right branch of the portal vein and the inferior vena cava (IVC) using a two-step biliary drainage set. An Amplatz gooseneck snare was introduced transjugularly to retrieve the percutaneously inserted guidewire. The intrahepatic tract between the portal vein and the IVC was dilated using a balloon catheter, and a stent was placed in the tract. The patient showed complete resolution of ascites at discharge. We assume that our method is an alternative method for TIPS creation in patients with inadequate anatomical relations between the portal vein branches and the hepatic veins. This approach is thought to be feasible for patients with occluded or small hepatic veins.