门静脉癌栓合并门脉高压症的TIPS姑息治疗

目的 评价门静脉癌栓（portal vein tumor thrombosis,PVTT) 合并门脉高压症患者行经颈静脉肝内门体静脉分流术（transjugular intrahepatic portosystemic shunt,TIPS)姑息治疗的疗效，并讨论其技术特点。方法 本组报告14例终末期肝癌合并门静脉癌栓及门静脉高压症患者，平均年龄53．6％。8例门静脉主干完全堵塞，6例门静脉主干及分支有不同程度栓塞，5例合并门静脉海绵样变。1例单纯上消化道大出血，3例单纯顽固性腹水，10例上消化道大出血合并顽固性腹水。结果 14例中10例患者成功行TIPS治疗，门静脉压力平均从术前37.2mmHg(1mmHg=0.133kPa)降至术后18.2mmHg，平均降低19.0mmHg；腹水减少或消失，消化道出血，腹胀，腹泻等症状缓解，平均生存32.3d。4例失败。结论 TIPS是姑息治疗肝癌合并门静脉癌栓引起的上消化道大出血和顽固性腹水的有效方法。

Palliative treatment of TIPS to portal vein tumor thrombosis complicated with portal vein hypertension

Objective To evaluate the palliative therapeutic effects of transjugular intrahepatic portosystemic shunt (TIPS) in portal vein tumor thrombosis (PVTT) complicated with portal vein hypertension, and to discuss the technical skills Methods There were14 cases of end stage hepatocellular carcinoma complicated with PVTT and portal vein hypertension, the average age was 53 6 yr There were 8 cases with complete occlusion of main portal vein, 6 cases with incomplete thrombosis, and 5 cases combined with portal vein cavernous transformation One case had simple hemorrhage, 3 cases had intractable ascites, and 10 cases had hemorrhage accompanied by intractable ascites Results The procedure of TIPS was successful in 10 cases, the successful rate was about 71% The mean portal vein pressure was reduced form 37 2 mm Hg to 18 2 mm Hg, with an average reduction of 19 0 mm Hg. After the procedure of TIPS, the ascites decreased, hemorrhage stopped and the clinical symptoms disappeared The average survival period was 132 3 days The procedure were failing in 4 cases Conclusion TIPS was an effective palliative therapeutic methods to control the hemorrhage and ascites aroused by hepatic carcinoma complicated with PVTT