经颈静脉途径肝内门体分流术的护理

经颈内静脉途径肝内门体分流术(TIPSS)是采用介入放射方法在局麻下经穿刺颈内静脉将肝静脉和门静脉沟通,在肝实质内建立门体分流通道。门静脉血流沿分流通道进入体循环,从而降低门静脉压力,有效地控制食管静脉曲张破裂出血,其疗效甚为显著,是近年来用于治疗门脉高压食管静脉曲张出血的新技术,由于方法新颖。创伤性小而在临床中逐步推广。我院自1994年开展此次技术以来共治疗了17例,现将护理报告如下。     

经颈静脉肝内门体分流术

经颈静脉肝内门体分流术中山医科大学附属第一医院消化内科任明，胡品津，林丽莉经颈静脉肝内门体分流术（ｔｒａｎｓｊｕｇｕｌａｒｉｎｔｒａｈｅｐ－ａｔｉｃｐｏｒｔｏｓｙｓｔｅｍｉｃｓｈｕｎｔ，ＴＩＰＳ）是一项近年应用于临床的介入放射学新技术，其基本概念是采...     

经颈静脉途径肝内门体分流术及护理

自１９９３年以来我院开展了１０例经颈静脉途径肝内门体分流术（简称ＴＰＳＳ），治疗肝硬化门静脉高压症取得了良好的效果。本文简要讨论了ＴＩＰＳＳ的治疗方法、操作步骤，阐明了ＴＩＰＳＳ的机理，详细提出了ＴＩＰＳＳ术的术前、术后护理重点。     

经颈静脉肝内门体分流术的护理

目的探讨经颈静脉肝内门体分流术(TIPS)的围手术期护理方法、效果和出院指导的重要性。方法回顾性分析2012年6月1日-2013年6月1日行TIPS术的258例患者的临床表现、围手术期的护理方法、出院指导建议,并对其行4~18个月的随访。结果 3例患者穿刺部位渗血,1例出现心悸,1例消化道出血,无肝性脑病发生。后期门诊随访发现12例患者发生消化道出血,3例发生肝性脑病。结论良好的护理方法和出院指导有助于提高疗效,减少TIPS术后并发症。     

右美托咪定经鼻使用在麻醉中的研究进展

右美托咪定为美托咪定的活性右旋异构体,是一种高效、高选择性的α2肾上腺素能受体激动剂,具有良好的镇静、镇痛和抗交感作用。同时对呼吸无抑制,可作为围手术期麻醉合并用药。右美托咪定经鼻给药是临床常用的方式之一,鼻腔黏膜毛细血管丰富,吸收药物迅速。与静脉给药相比,经鼻给药无创简便、刺激性小,起效缓慢平稳、易于被患者接受,因而在临床上广泛用于围手术期或手术室外有创检查等操作的镇静、镇痛。     

经颈静脉肝内门体静脉支架分流术的护理进展

综述了经颈静脉肝内门体静脉支架分流术的护理进展。具体内容包括术前护理、术中护理、术后护理以及出院指导,认为作为一种非外科手术治疗门脉高压症的新方法,TIPS仍具有多种并发症,护理人员应给予针对性的围手术期护理措施,以提高患者的术后治疗效果和生活质量。     

经颈静脉肝内门体静脉分流术的护理

经颈静脉肝内门体静脉分流术（TIPS）,就是在X线透视下行颈内静脉穿刺,经上腔静脉、右心房、下腔静脉至肝静脉,自肝静脉穿刺至门静脉分支,建立肝静脉和门静脉之间的分流道,并植入支架,维护分流道通畅,达到降低门静脉压力,控制食管胃底静脉曲张破裂出血、促进脾脏缩小、腹水吸收。该技术可用于治疗肝硬化门脉高压并发的食管胃底静脉曲张破裂出血和顽固性腹水,具有创伤小、不需全身麻醉、手术时间较短、并发症少等优点,术中可同时对出血的胃冠状静脉进行硬化剂或栓塞剂治疗。     

经颈静脉肝内门体静脉分流术的护理

经颈静脉肝内门体静脉分流术(TIPS), 就是在X线透视下行颈内静脉穿刺,经上腔静脉、右心房、下腔静脉至肝静脉,自肝静脉穿刺至门静脉分支,建立肝静脉和门静脉之间的分流道,并植入支架,维护分流道通畅,达到降低门静脉压力,控制食管胃底静脉曲张破裂出血、促进脾脏缩小、腹水吸收[1].该技术可用于治疗肝硬化门脉高压并发的食管胃底静脉曲张破裂出血和顽固性腹水,具有创伤小、不需全身麻醉、手术时间较短、并发症少等优点,术中可同时对出血的胃冠状静脉进行硬化剂或栓塞剂治疗[2].     

经颈静脉行肝内门体分流术患者的护理

经颈静脉途径行肝内门体分流术，是近年来国外开展非手术治疗门脉高压症的新方法。它具有疗效可靠，创伤性小，方法简便，患者易于接受等优点。我院于１９９３年３月在国内首先开展，并成功地治疗１６例患者。本文介绍了该治疗方法及护理人员与医师密切合作，对患者实施整体护理，保证该治疗获得成功的护理体会。     

经颈静脉肝内门体分流术的围手术期护理

目的总结经颈静脉肝内门体分流术（transjugular intrahepatic portasystemic stent shunt,TIPS）围手术期的护理。方法2006年1月-2009年8月行TIPS患者119例,术前加强并做好患者的心理护理、术前指导和各项准备,术后重视并发症的观察及护理。结果除1例死亡外,其余均好转出院。结论TIPS是治疗肝硬化的一种新兴的介入治疗术,做好围手术期护理,可及时发现并发症,提高手术成功率和患者满意度。     

Dynamic changes in liver function after transjugular intrahepatic portosystemic shunt in patients with cirrhosis

PurposeTo evaluate the dynamic changes in liver function after transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with cirrhosis and to explore its association with clinical outcomes.MethodsThis retrospective study included patients who underwent TIPS between August 2016 and December 2020. Liver function was primarily evaluated using the model for end-stage liver disease (MELD) score, which was analyzed at baseline, 1 week, 1 month, 3 months, 6 months, and 12 months using one-way repeated measures ANOVA. The Kaplan-Meier method, log-rank test, and multivariate analysis were used as appropriate.ResultsIn total, 235 patients were included in this study. The MELD score was significantly higher at 1 week (11.8 ?± ?3.1 vs 13.5 ?± ?3.5, p ?< ?0.05) and 1 month (11.8 ?± ?3.1 vs 13.2 ?± ?4.6, p ?< ?0.05) than the baseline level and recovered at 3 months (11.8 ?± ?3.1 vs 11.9 ?± ?3.9, p ?> ?0.05). At 12 months, the MELD score was higher than the baseline level (11.8 ?± ?3.1 vs 12.4 ?± ?3.2, p ?< ?0.05). Patients with a recovery of the MELD score (n ?= ?151) at 3 months had a lower probability of overt and severe HE (log-rank p ?= ?0.015 and p ?= ?0.027, respectively) than those without recovery (n ?= ?84). Logistic regression analysis revealed that albumin (odds ratio [OR], 0.926; 95% confidence interval [CI], 0.863–0.992; p ?= ?0.029) and platelet count (OR, 0.993; 95% CI, 0.987–0.999; p ?= ?0.033) were independent predictive factors for non-recovery of the MELD score at 3 months.ConclusionsLiver function after TIPS creation showed a trend of deterioration at first, followed by recovery. Recovery of liver function at three months was associated with reduced overt and severe HE.     

Temporary pacemaker protected transjugular intrahepatic portosystemic shunt in a patient with acute variceal bleeding and bradyarrhythmia: A case report

BACKGROUNDEsophagogastric varices are a common complication of cirrhosis with portal hypertension and endoscopic treatment has been recognized as a primary preventive and therapeutic option for such patients; however, it should be noted that bradyarrhythmia is regarded as one of the contraindications to endoscopic examination. Meanwhile, acute variceal bleeding may result in a high mortality rate in cirrhotic patients with portal hypertension accompanied by bradyarrhythmia. At present, there is an absence of reports concerning the treatment of such group of patients who underwent transjugular intrahepatic portosystemic shunt (TIPS). The present report details the case of a cirrhotic patient with acute variceal bleeding accompanied by bradyarrhythmia who underwent TIPS under temporary pacemaker protection.CASE SUMMARYWe report the case of a 64-year-old male patient who was confirmed with bradyarrhythmia by ambulatory electrocardiogram 24 h before the operation. The patient was successfully treated by TIPS under temporary pacemaker protection.CONCLUSIONIn terms of cirrhotic patients with abnormal cardiac electrophysiological conduction, TIPS may be effective in reducing the complications of portal hypertension following the exclusion of severe pulmonary hypertension and heart failure, showing moderate feasibility in clinical applications.     

彩色多普勒超声在限制性经颈静脉肝内门体分流术联合食管胃底曲张静脉组织胶栓塞术中的应用

目的彩色多普勒超声评价限制性经颈静脉肝内门体分流术(TIPS)联合食管胃底曲张静脉组织胶栓塞手术(SEVE)前后门静脉及分流道血流动力学特征。方法 51例行TIPS联合SEVE患者,于术前及术后1周,1、6、12个月,超声测量门静脉内径和最大血流速度,观察门静脉主干及左右分支内血流方向和门静脉有无血栓,术后超声测量分流道支架内径和最大血流速度,观察有无血流及血流方向。结果 51例患者术后随访期间无一例死亡,生存率为100%;发生肝性脑病4例,发生率为8%;再出血8例,发生率为16%;支架狭窄及闭塞各2例,总发生率为8%。门静脉内径术前至术后12个月变化差异无统计学意义。门静脉血流速度术后1周,1、6、12个月较术前增大(P0.001);术后6、12个月均较术后1周,1个月减小(P0.05)。37例门静脉分支内可见反流,占73%。术后6、12个月支架内血流速度较术后1周,1个月下降(P0.05)。结论彩色多普勒超声已成为术前检查及术后随访的首选方法,术后门静脉和支架血流速度呈缓慢下降。     

Percutaneous transhepatic intrahepatic portosystemic shunt for variceal bleeding: A series of six cases and literature review

ObjectivesTo present a case series of modified transjugular intrahepatic portosystemic shunts (TIPS) and percutaneous transhepatic intrahepatic portosystemic shunts (PTIPS) in cirrhotic patients with variceal bleeding (VB). In addition, the scientific literature pertaining to PTIPS was reviewed.MethodsThis retrospective clinical case series included six cirrhotic patients with VB who were treated with PTIPS after the failure of endoscopic band ligation or endoscopic injection sclerotherapy combined with vasoactive drugs. The treatment was conducted between January 2017 and June 2019 at a single institution. Three patients suffered from severe atrophy of the right or left lobar of the liver as well as the main right or left branch of the portal vein. The remaining three patients showed severe atrophy of the whole liver and portal vein, resulting in widening of the liver fissure. A paired t-test was used to compare the changes in portal pressure gradient between before and after the PTIPS operation. The rebleeding rate, treatment efficacy, complications, and technical success rate were all assessed during follow-up.ResultsAll six PTIPS procedures were performed successfully, with no severe procedural-related complications observed. None of the patients experienced VB during a mean follow-up of 22.8 (range, 18.0–28.0) months. The mean portosystemic pressure gradient decreased from 28.3 ​± ​4.3 ​mmHg pre-procedure to 12.3 ​± ​2.6 ​mmHg immediately post-procedure (P ​< ​0.001). At follow-up, one patient was found to have developed grade 2 hepatic encephalopathy thrice during the first year, according to the West Haven criteria. However, this was resolved following medical treatment.ConclusionsWhen the patient’s portal venous anatomy is unconducive to the performance of TIPS using the transjugular approach, PTIPS can be considered as a safe, effective complementary surgical approach for patients with VB.     

颈静脉肝内门体分流术治疗门静脉高压并门静脉广泛栓子后消化道出血三例

目的探讨经颈静脉肝内门体分流术（TIPS）治疗门静脉高压并门静脉内栓子广泛形成后消化道出血的治疗效果。方法3例急性上消化道出血患者,均经CT明确诊断为门静脉、肠系膜上静脉内（含1例脾静脉内栓子形成）广泛栓子形成,行TIPS止血治疗,将支架放置于造影所见栓子的远端。结果TIPS治疗后,随访4～6周3例患者均未再发生出血,不适症状消失。结论TIPS治疗门静脉高压并门静脉内广泛栓子形成后消化道出血,安全可行,疗效可靠,值得推广。     

声触诊组织量化技术评估经颈静脉肝内门体分流术联合胃冠状静脉栓塞术疗效

目的 探讨应用声触诊组织量化(VTQ)技术测量脾脏剪切波速度(SSWV)无创评价经颈静脉肝内门体分流术(TIPS)联合胃冠状静脉栓塞术(GCVE)疗效的价值。方法 将19例接受TIPS联合GCVE治疗的肝硬化门静脉高压患者分为A(13例,接受1次治疗)、B(6例,首次治疗后因支架闭塞再次接受治疗)两组。应用VTQ技术分别与治疗前1天、治疗后6天测量SSWV,以脉冲波多普勒测量门静脉主干血流速度(PVV)、脾静脉主干血流速度(SVV)。于TIPS联合GCVE治疗过程中,以直接测压法测量支架植入前及植入后的门静脉压(PPG),并进行统计分析。结果 TIPS联合GCVE治疗后,A、B两组PPG均较治疗前明显减低(P均<0.05);SSWV均较治疗前明显减低,PVV、SVV均较治疗前明显升高(P均<0.05)。A、B两组治疗前及治疗后SSWV均与PPG呈正相关(P均<0.05),PVV、SVV均与PPG无相关性(P均>0.05)。结论 应用VTQ技术所测SSWV与PPG存在相关性,可作为TIPS联合GCVE治疗前后监测门静脉压力的无创定量评估指标。     

Transjugular intrahepatic portosystemic shunt plus embolization for bleeding esophagojejunal varices after total gastrectomy

A 64-year-old man was admitted to our hospital with hematemesis and melena. Six years ago, he had undergone total gastrectomy with Roux-en-Y esophagojejunostomy for gastric cancer. Endoscopic examination revealed varicose veins at the anastomotic sites with cherry-red spots and hemorrhage. Abdominal computed tomography showed that the varices were supplied by a dilated jejunal vein. Transjugular intrahepatic portosystemic shunt (TIPS) and variceal embolization were performed. There were no major complications or episodes of bleeding during the three-month follow-up. We conclude that TIPS in combination with varices obliteration is an effective alternative method for treatment of ruptured esophagojejunal varices after total gastrectomy.     

Clinical efficacy of transjugular intrahepatic portosystemic shunt created through left or right branches of the portal vein: A meta-analysis

Background and aimTransjugular intrahepatic portosystemic shunt (TIPS) is a technique successfully used to treat portal hypertension and its complications. However, the choice of the branch, left (L) or right (R), of the portal vein resulting in a better outcome is still under debate. Therefore, this meta-analysis aims to evaluate which branch has a better curative effect on patients treated with TIPS.MethodsPubMed, EMBASE, Web of science, Cochrane Library databases, Wanfang database and CBM were used for our search in October 2019 and updated in June 2021. The following parameters were used in evaluation: overall mortality, hepatic encephalopathy, shunt dysfunction, variceal rebleeding and rate of postoperative ascites.ResultsThere were seven studies included. The sample size was 1940. A lower risk of mortality was observed in TIPS-L-treated patients compared with TIPS-R-treated ones (OR ​= ​0.65, 95% CI ​= ​0.50–0.85, p ​= ​0.002). A lower risk of shunt dysfunction was observed in TIPS-L-treated patients compared with TIPS-R-treated ones (OR ​= ​0.53, 95% CI ​= ​0.33–0.87, p ​= ​0.01). And the TIPS-L group had a significantly higher hepatic encephalopathy-free rate than the TIPS-R group (OR ​= ​0.59, 95% CI ​= ​0.44–0.78, p ​= ​0.0002). However, the rate of rebleeding (OR ​= ​0.75, 95% CI ​= ​0.55–1.03, p ​= ​0.07) and incidence of postoperative ascites (OR ​= ​1.14, 95% CI ​= ​0.86–1.51, p ​= ​0.38) was not statistically significant between the two groups.ConclusionsBased on the currently available evidence, the technique of TIPS through the left branch of the portal vein can significantly reduce the occurrence of overall postoperative mortality, hepatic encephalopathy and shunt dysfunction.