^99mTc动脉显像观察TIPS加改良Sugiura术对门静脉高压症病人门静脉血流循

目的 研究经颈内静脉肝内门体分流术（ＴＩＰＳ）加改良Ｓｕｇｉｕｒａ术对门静脉高压症病人门静脉血流循环、肝外门体分流情况的影响。方法 对１４例门静脉高压症病人,进行治疗前后的＾９９ｍＴｃ动脉显像、直接门静脉测压自身对比研究。结果 术前、ＴＩＰＳ及改良Ｓｕｇｉｕｒａ术后病人的肝脏、门静脉开始显影时间分别显著提前;门静脉压力逐步降低;ＴＩＰＳ术后门体分流率（ｓｈｕｎｔ ｉｎｄｅｘ,ＳＩ）明显下降,而改良Ｓｕｇｉｕｒａ术后无显著变化;肝脏放射性－时间曲线斜率上升。结论 ＴＩＰＳ加改良Ｓｕｇｉｕｒａ术造成的门静脉及肝外门体分流的改变有助于提高治疗门静脉高压症的临床疗效。     

TIPS,改良Sugiura术和TIPS加改良Sugiura术治疗门静脉高压症 …

目的 探讨ＴＩＰＳ、改良Ｓｕｇｉｕｒａ术和ＴＩＰＳ加改良Ｓｕｇｉｕｒａ术治疗门静脉高压症的临床疗效。地对９０例门静脉高压症患者分别行ＴＩＰＳ、改良Ｓｕｇｉｒａ和ＩＰＳ加改良Ｓｕｇｉｕｒａ术治疗。结果 Ⅰ、Ⅱ、Ⅲ组近期并发症分别为２３．３３％￣３０．００％和２０．００％,其中,出血复发率为６．６７％、１０．００％和０％,肝性脑为１６．６７％、０％和１３．３３％,Ⅰ组病死率为３．３３％,术后１￣３６个     

经颈内静脉肝内门体分流术的疗效观察及对门静脉血流动力学的…

作者研究了经颈内静脉肝门体分流术（ＴＩＰＳＳ）治疗门静脉压症的临床疗效及对门静脉血流动力学的影响，对１４０例门静脉高压症患者实施了ＴＩＰＳＳ治疗。采用超声多普勒，门静脉造影和测压观察了１００例患者门静脉血流动力学的改变，ＴＩＰＳＳ技术成功率９４．６２％，操作并发症发生率４．６２％，轻度肝性脑病９．０３％，术后死亡率３．０８％，术后１～２４个月随访，分流道狭窄或阻塞率１２％，症状复发率９．０％，死亡     

TIPS治疗门静脉高压症的优点与不足

经颈内静脉肝内门体分流术 (ＴＩＰＳ)应用于治疗门静脉高压症已有十余年历史。通过长期的探索和研究表明 ,ＴＩＰＳ的设计构思合理 ,有创新性 ,操作技术日趋完善 ,对其特性、远期疗效及对机体的影响有了充分的了解 ,从而确定了ＴＩＰＳ在门静脉高压症治疗中的价值。ＴＩＰＳ的优点在于手术创伤小、技术成功率高、操作并发症低、适应范围广、降低门静脉压力显著和控制食管静脉曲张出血疗效可靠 ,具有良好的近期疗效。ＴＩＰＳ主要适用于 :(1)门静脉高压症伴食管静脉曲张破裂大出血经保守治疗无效者。ＴＩＰＳ近期止血率大于 90 %。 (2 )预防…     

门静脉高压患者TIPSS手术前后的氧动力学监测

目的 观察门静脉高压症患者行ＴＩＰＳＳ手术后氧供、氧耗的变化,探讨ＴＩＰＳＳ对机体氧动力学的影响。方法 １４例门脉高压患者ＴＩＰＳＳ治疗,分别手术前、术后３０分钟和术后２周经右颈内静脉置入Ｓｗａｎ－Ｇａｎｚ导管监测血流动力学和氧供、氧耗、氧摄取率。结果 ＴＩＰＳＳ术后患者心脏指数明显增加,氧供明显增加,但氧耗无显著变化。结论 ＴＩＰＳＳ手术加重心脏负担,增加氧供,但机体通过代偿机制能够维持正常氧耗     

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门奇静脉断流术是预防和治疗门静脉高压症伴食管静脉曲张出血的主要方法。然而 ,断流术后再出血发生率高达 10 %～ 30 % ,术后再出血严重影响断流术的临床疗效。经颈内静脉肝内门体分流术 (ＴＩＰＳ)是治疗断流术后再出血最为重要的介入方法 ,对控制食管静脉曲张破裂出血或门静脉高压性胃粘膜病变所致的出血有着极为重要的价值[1,2 ] 。我院自 1993年以来采用ＴＩＰＳ治疗断流术后再血31例。本文结合该 31例资料及有关文献进一步探讨ＴＩＰＳ治疗断流术后再出血的临床作用。1993年 8月至 1999年 8月我院对 31例门静脉高压症断流术后再出血病…     

直接门静脉造影在门静脉高压症断流术中的作用

曲张的冠状静脉是形成门静脉高压症食管静脉破裂出血的重要侧支血管,其解剖变异导致断流不彻底,是断流术后再出血的重要原因。我院１９９３年７月～１９９９年８月对３１例门静脉高压症断流术后再出血病人在ＴＩＰＳ操作过程中行直接门静脉造影,观察和分析冠状静脉与断流术后再出血的关系;又于１９９６年７月～２０００年１２月对另５０例门静脉高压症伴食管静脉曲张出血病人先行ＴＩＰＳ,２周后再行断流术,通过直接门静脉造影观察治疗前后冠状静脉的改变。材料与方法１９９３年７月～１９９９年８月,我院对３１例门静脉高压症断流术…     

经颈内静脉肝内门体分流术操作中的经验和教训

１９９３年７月￣１９９５年１月，作者对１１０例晚期肝硬化门静脉高压症患者实施ＴＩＰＳＳ治疗，成功率为９５．１５％（７例门静脉血栓放弃ＴＩＰＰ操作）。与ＴＩＰＳＳ操作有关的并发症发生率为２．９１％，并发症包括腹腔内出血２例，右侧胸腔内出血１例；术后１个月内死亡率是３．８８％，死亡原因是急性肝功能衰竭和食管静脉曲张再出血，无１例与ＴＩＰＳＳ操作有关。１￣１９个月随访，出血、腹水复发５例，肝功能衰竭死亡     

经颈内静脉肝内门体分流术的疗效观察及对门静脉血流动力学的影响

作者研究了经颈内静脉肝内门体分流术（ＴＩＰＳＳ）治疗门静脉高压症的临床疗效及对门静脉血流动力学的影响。对１４０例门静脉高压症患者实施ＴＩＰＳＳ治疗，采用超声多普勒、门静脉造影和测压观察了１００例患者门静脉血流动力学的改变。ＴＩＰＳＳ技术成功率９４．６２％，操作并发症发生率４．６２％，轻度肝性脑病９．０３％，术后死亡率３．０８％；术后１～２４个月随访，分流道狭窄或阻塞率１２％，症状复发率９．０％，死亡率６．０％。肝内分流道建立后门静脉压力和肝外门体分流量显著下降，门静脉流速增加，分流道通畅者分流道和门静脉流速分别下降１１．９３％和２０．１４％，分流道狭窄者流速进一步下降。ＴＩＰＳＳ治疗门静脉高压症疗效显著，动态观察血流变化有助于早期诊断和治疗分流道狭窄或阻塞。     

经颈内静脉肝内门体分流术操作中的经验和教训

１９９３年７月～１９９５年１月，作者对１１０例晚期肝硬化门静脉高压症患者实施ＴＩＰＳＳ治疗，成功率为９５．１５％（７例门静脉血栓放弃ＴＩＰＰ操作）。与ＴＩＰＳＳ操作有关的并发症发生率为２．９１％，并发症包括腹腔内出血２例，右侧胸腔内出血１例；术后１个月内死亡率是３．８８％，死亡原因是急性肝功能衰竭和食管静脉曲张再出血，无１例与ＴＩＰＳＳ操作有关。１～１９个月随防，出血、腹水复发５例，肝功能衰竭死亡３例。肝癌死亡２例。作者总结ＴＩＰＳＳ操作的经验，讨论与ＴＩＰＳＳ操作有关的几个问题。     

TIPSS在门静脉高压症治疗中的临床价值

研究经颈内静脉肝内门体分流术(TIPSS)在门静脉高压症治疗中的价值。方法:1993年8月～1998年8月,我院对200例门静脉高压症患者实施TIPSS治疗,其中20例行TIPSS与Sugiura改良术联合治疗。结果:TIPSS的技术成功率为94.59％,术后近期死亡率3.87％,出血复发率2.58％,轻度肝性脑病18.71％。经1至5年随访,出血和腹水复发率分别为27.08％和41.18％,分流道狭窄阻塞率30.77％,死亡率28.46％;TIPSS加改良Sugiura术后经1～24月随访,无出血复发,肝内分流道保持通畅。结论:TIPSS与改良Sugiura术的联合应用,可提高门静脉高压症的临床疗效。     

Portal hypertension and ascites

Portal hypertension is secondary to increased resistance to blood flow and increased blood flow through the portal system. The most common cause is liver cirrhosis. The most severe and life-threatening presentation of portal hypertension is acute variceal bleeding. Pharmacotherapy with vasoactive agents (terlipressin or somatostatin), endoscopic band ligation and radiological treatment with transjugular intrahepatic portosystemic shunt (TIPSS) are the most common treatment options for variceal bleeding. However, where surgical expertise exists, portosystemic shunts can be considered for refractory bleeding in patients without significant liver failure, especially when TIPSS is unavailable or contraindicated. Diuretic therapy with spironolactone and furosemide are the basis for the management of ascites. If ascites becomes refractory, repeat large volume paracentesis and TIPSS are potential treatment options. Liver transplantation offers the definitive treatment for portal hypertension secondary to cirrhosis as it cures the underlying liver disease.     

改良Sugiura术治疗门静脉高压70例分析

目的探讨改良Sugiura术治疗门静脉高压症引起的食管下端胃底曲张静脉破裂出血的安全性和有效性。方法对我院2004年1月至2010年8月治疗的70例门静脉高压症并出血的病例进行回顾性总结分析。结果术前自由门静脉压力为（38．71±7．71）cmH2O,断流术后为（32．33±7．61）cmH2O,二者相比差异有统计学意义（P〈0．05）。10例急诊手术,止血率达90％。围手术期死亡3例,30例少量腹水,胸腔积液20例,门静脉血栓8例。术后消化道再出血7例,其中1例为急诊手术患者。结论改良Sugiura术是治疗门静脉高压症引起的食管下端胃底曲张静脉破裂出血的是一种安全、有效的方法。     

门静脉压力改变对门静脉高压症肠道通透性的影响

目的　观察门静脉压力改变对门静脉高压症患者肠道通透性的影响。　方法　门静脉高压症患者 2 0例分为 2组 ,每组 10例 ,A组采用经颈内静脉肝内门体分流术 (transjugularintrahepaticportosystemicshunt,TIPS)加改良Sugiura联合治疗 ,B组行改良Sugiura治疗。分别于术前、TIPS后 2周和改良Sugiura术后 2周行肠道通透性检查 ;2 0例健康志愿者作对照。　结果　门静脉高压症患者较健康志愿者肠道通透性明显升高 (0 132± 0 110vs 0 0 32± 0 0 18,P <0 0 1)。A组患者TIPS术后 2周门静脉压力和肠道通透性均显著降低 (P <0 0 5 ) ;改良Sugiura术后 2周 ,2者无显著变化 ,但较术前明显降低 (P <0 0 5 )。B组患者改良Sugiura术后 2周肠道通透性和术前相比无显著变化。A、B组患者术前肠道通透性相比无显著差异 ,改良Sugiura术后 ,A组明显降低 (P <0 0 5 )。研究还发现门静脉压力与肠道通透性之间有显著相关性 (r=0 6 2 7,P <0 0 1)。　结论　研究表明TIPS加改良Sugiura术降低门静脉压力 ,改善肠道通透性 ,提高临床疗效。     

Portal hypertension and ascites

Portal hypertension is secondary to increased resistance to blood flow and increased blood flow through the portal system. The commonest cause is liver cirrhosis. The most severe and life-threatening presentation of portal hypertension is acute variceal bleeding. Pharmacotherapy with vasoactive agents (terlipressin or somatostatin), endoscopic band ligation and radiological treatment with transjugular intra-hepatic portosystemic shunt (TIPSS) are the commonest treatment options for variceal bleeding. However, where surgical expertise exists, portosystemic shunts can be considered for refractory bleeding in patients without significant liver failure, especially when TIPSS is unavailable or contraindicated. Diuretic therapy with spironolactone and furosemide are the basis for the management of ascites. If ascites becomes refractory, repeat large volume paracentesis and TIPSS are potential treatment options. Liver transplantation offers the definitive treatment for portal hypertension secondary to cirrhosis as it cures the underlying liver disease.     

经颈内静脉肝内门体分流术对门静脉高压症患者门静脉及全身血 …

研究经颈内静脉肝内门体分流术对门静脉和全身血流动力学的影响。方法 采用超声多普勒,直接门静脉测压和血气分析,Ｓｗａｎ－Ｇａｎｚ导管对１５例静脉高压症患者检测ＴＩＰＳＳ术前后门静脉,体循环和肺循环血流动力学的变化。结果ＴＩＰＳＳ术后３０分种和２周,门静脉压力下降３４％和５５．４％,氧分压和氧饱和度增加６７．７％,２１．３％和６８．０％,２０．４％。     

Portal hypertension and ascites

Portal hypertension occurs secondary to increased resistance to portal blood flow. It is a principle consequence of liver cirrhosis and leads to severe life-threatening complications, such as variceal bleeding, ascites and hepatic encephalopathy. Acute variceal bleeding is a medical and surgical emergency requiring a multidisciplinary management approach. Prompt resuscitation along with pharmacotherapy agents (terlipressin or somatostatin analogues) followed by early endoscopic variceal banding is the cornerstone of effective treatment. Refractory bleeding despite endoscopic band ligation requires emergency trans-jugular intrahepatic portosystemic shunt (TIPSS). Diuretic therapy with spironolactone and furosemide are the first line of management of ascites. If ascites becomes refractory, repeat large volume paracentesis (LVP) and TIPSS are potential treatment options. Liver transplantation remains the only curative option for all patients with portal hypertension, but a careful selection policy and assessment is mandatory when considering transplantation.     

Liver transplantation in patients with transjugular intrahepatic portosystemic shunts

BACKGROUND: In patients with intractable oesophageal variceal bleeding, transjugular intrahepatic portosystemic shunts (TIPSS) are being used increasingly as a bridge to orthotopic liver transplantation (OLTx). There is little information in the literature concerning variations in the operative techniques of OLTx required because of the presence of TIPSS. METHODS: A retrospective review of patients treated by TIPSS prior to OLTx was undertaken. The aims were to assess the effectiveness of TIPSS in bridging patients to OLTx and to examine whether TIPSS influence the operative management of OLTx. RESULTS: Over a 4-year period eight adult patients underwent TIPSS insertion prior to OLTx in the Australian National Liver Transplant Unit (ANLTU). Transplantation was performed at a mean of 14.6 (0.3-53.8) months after TIPSS insertion. Prevention of major recurrent variceal haemorrhage prior to transplantation was achieved in six cases. In two patients the stents were predominantly intrahepatic and they did not interfere with OLTx. In five patients the stents extended into the portal vein, requiring removal during OLTx either by division of the stent with the recipient portal vein, followed by removal of the fractured stent wires from the portal veins (n = 3), or by 'endarterectomy' of the recipient portal vein, allowing removal of the intact stent (n = 2). In one case where the stent extended into the suprahepatic inferior vena cava, removal was achieved by traction without difficulty. All patients are alive at a mean of 24 (7-53) months post-transplant and none has portal vein abnormalities. When compared to 178 adult patients who had no TIPSS and underwent primary OLTx during the same study period, there was no difference in the length of operating time or the usage of blood products during OLTx. CONCLUSION: Transjugular intrahepatic portosystemic shunts offer a bridge to OLTx by providing effective control of variceal haemorrhage. In the present series TIPSS did not increase surgical morbidity or mortality, but emphasis is placed upon the need for optimal TIPSS placement within the liver to facilitate subsequent OLTx.     

门静脉高压症患者冠状静脉解剖变异及临床意义

目的　研究门静脉高压症患者冠状静脉解剖变异、返流情况及临床意义。　方法　采用直接和间接门静脉造影、测压和超声多普勒观察 2 0 0例门静脉高压症患者冠状静脉解剖、门静脉压力和血流。　结果　门静脉高压症患者单支冠状静脉占 79 4 6% ,双支冠状静脉占 2 0 5 4 % ,开口于门静脉主干、脾静脉和门脾静脉交汇处分别为 62 3 3 %、2 7 3 5 %和 8 0 7% ,出血和断流术后再出血患者冠状静脉开口主要位于门静脉主干 ,顽固性腹水无出血者多数位于脾静脉 ;间接门静脉造影示Ⅱ、Ⅲ级、门静脉血栓和活动性出血患者冠状静脉显示率分别为 2 6 19%、5 6 64 %、10 0 %和 10 0 % ,出血静止期和无出血顽固性腹水者分别为 4 7 79%和 19 0 5 %。　结论　冠状静脉解剖变异是影响食管静脉曲张出血的重要因素 ,返流是出血的重要标志。     

TIPS及其分别联合CVO、门奇静脉断流术治疗门静脉高压症的疗效比较

目的:研究经颈内静脉肝内门体分流术(TIPS)、TIPS联合冠状静脉栓塞术(CVO)、TIPS联合门奇静脉断流术治疗门静脉高压症的临床疗效.方法:回顾性分析1993年7月至2008年5月收治的358例门静脉高压症伴食管静脉曲张患者的临床资料,所有患者分为3组,分别为TIPS组(n=227)、TTPS联合CVO组(n=36)和TIPS联合门奇静脉断流术组(n=95).观察3组患者在手术成功率、并发症发生率、近期和远期分流道通畅率、再出血率、肝性脑病发生率和病死率方而的情况,并应用统计学方法比较其差异.结果:成功完成TIPS操作349例,成功率为97.5%,TIPS失败患者9例,占2.5%.术后1个月分流道的阻塞率、肝性脑病发生率、再出血率和病死率分别为2.5%、31.8%、4.7%和9.0%.其中,TIPS组患者的肝性脑病发生率和病死率均高于TIPS联合门奇静脉断流术组(P<0.01).急诊行TIPS 85例,术后肝性腑病发生率和病死率分别为41.2%和24.7%.术后随访1～15年,平均(68.7±47.6)个月,随访率为79.6%.术后1、2年分流道通畅率分别为74.0%和48.1%,其中TIPS联合门奇静脉断流术组术后1年分流道通畅率显著高于TIPS组和TIPS联合CVO组(P<0.01和P<0.05).TIPS联合门奇静脉断流术组术后再出血率低于TIPS组(P<0.01),远期生存率高于TIPS组和TIPS联合CVO组(P<0.01).结论:TIPS是治疗门静脉高压症伴食管静脉曲张出血的有效方法,与CVO或断流术联合应用可提高临床疗效.