声触诊组织量化技术无创评价经颈静脉肝内门-腔分流术疗效的可行性研究

目的 探讨声触诊组织量化(virtual touch tissue quantification,VTQ)技术无创评价经颈静脉肝内门-腔分流术(transjugular intrahepatic portosystemic stent shunt,TIPSS)疗效的可行性.方法 应用VTQ技术对24例肝硬化门静脉高压预行TIPSS分流术患者分别测量手术前后肝、脾剪切波速度(shear wave velocity,SWV);并于手术时测量门静脉压力(portosystemic pressure gradient,PPG);比较手术前后肝、脾SWV值的变化及与PPG的相关性.同时对14例患者进行术后1个月的随访.结果 PPG 和脾SWV值在手术前为(27.87±4.68) mm Hg和(3.49±0.40) m/s,术后为(16.46±3.76) mm Hg和(3.08±0.39)rn/s,两者的差异均有统计学意义(P均＜0.05);肝SWV值在手术前后的差异无统计学意义(P=0.130).脾SWV值与PPG呈高度正相关(r=0.602,P=0.000);肝SWV值与PPG无相关性(r=0.154,P=0.296).14例随访患者术前、术后1周、术后1个月的脾SWV值两两比较差异均有统计学意义(P均＜0.05);而肝SWV值两两比较差异均无统计学意义(P均＞0.05).结论 VTQ技术测量的脾SWV值可用于定量监测TIPSS分流术前后门静脉压力的变化,无创评价手术疗效,但目前还未发现肝SWV值可以用于评价其手术疗效.     

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。     

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。     

经颈静脉肝内门腔分流术的护理

经颈静脉肝内门腔分流术的护理５１０５１５第一军医大学南方医院穆红霞经颈静脉肝内门腔分流术（Ｔｒａｎｓｊｕｇｕｌａｒｉｎｔｒａｈｅｐａｔｉｃｐｏｒｔａｌ－ｓｙｓｔｅｍｉｃｓｈｕｎｔｓ，ＴＩＰＳ）是近年才开展的介入性放射医学新技术。由于本术具有创伤小、适...     

经颈静脉肝内门腔静脉分流术的护理体会

经颈静脉肝内门腔静脉分流术的护理体会广州南方医院５１０５１５徐伟，于萍经颈静脉肝内门腔静脉分流术（简称ＴＩＰＳＳ）是近年来临床治疗肝硬化门脉高压症的一种新技术。ＴＩＰＳＳ是利用一根记忆性金属支架，使门静脉与肝静脉沟通，从而降低门脉高压，减少出血机率，...     

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。     

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。     

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。     

右美托咪定监护下麻醉在经颈静脉肝内门体静脉分流术中的应用

目的观察右美托咪定监护下麻醉(MAC)用于经颈静脉肝内门体静脉分流术(TIPS)的麻醉效果。方法4 0例拟行TIPS的患者随机分为右美托咪定组(D组,n=20)和丙泊酚组(P组,n=20),D组和P组首先分别给予负荷剂量的右美托咪定和丙泊酚,然后调整两组的给药剂量使Ramsay镇静评分维持于2~4分,两组患者术前均给予0.1μg/kg的舒芬太尼,且术中酌情追加0.05μg/kg每次。记录麻醉前(T0)、手术开始前(T1)、球囊扩张时(T2)、支架植入时(T3)、术毕(T4)时的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SPO2),舒芬太尼用量、呼吸抑制发生例数、手术时间、清醒时间等。结果 MAP:T1时,P组较D组明显下降(P0.05);T2、T3时,P组的MAP较D组明显升高(P0.05);HR:T3时,P组较D组明显升高(P0.05);SPO2:T1、T2、T4时,P组较D组明显降低(P0.05);P组的苏醒时间长于D组(P0.05);P组的舒芬太尼用量、呼吸抑制的发生例数较D组高(P0.05)。结论右美托咪定行MAC用于TIPS术安全可行。     

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.     

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.     

CDFI与实时组织弹性成像联合监测在肝硬化经颈静脉肝内门体分流术术后疗效的临床价值

目的 探讨CDFI和实时组织弹性成像(RTE)联合监测在肝硬化经颈静脉肝内门体分流术(TIPSS)术后疗效的临床价值.方法 对临床46例肝硬化门脉高压经TIPSS术前、术后进行CDFI和RTE检查.观察门静脉、脾静脉内径和血流变化情况;通过组织弥散定量分析软件分析肝硬化弥散指标变化情况.结果 TIPSS术后门静脉内径变小,门静脉、脾静脉流速增快,与术前比较差异有统计学意义(P＜0.05),脾静脉内径改变不明显,与术前比较差异无统计学意义.TIPSS术后蓝色领域百分比增高,复杂度、峰度、偏度减低,与术前比较差异均有统计学意义(均P＜0.05),TIPSS术前、后应变均值、标准偏差、对比度、均等性、杂乱度、一致性及相关性改变不明显.结论 CDFI技术在观察TIPSS术前后血管内径、血流速方面改变比较明显;RTE能观察到肝硬化TIPSS术后肝硬度的改变情况.二者联合诊断肝硬化TIPSS术后价值更高.     

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.