经颈静脉肝内门体分流术

经颈静脉肝内门体分流术(Transjugular Intrahep-atic portosystemic stent shunt,TIPSS)是近年来发展的一种门脉高压症的介入放射治疗技术。它是在肝实质内形成门静脉肝内分支与肝静脉之间的人工瘘道,从而达到降低门脉压力的目的。TIPSS 操作较外科手术简例,适应证广,降低门脉压力可靠。本文对 TIPSS 的     

初探经颈静脉肝内门体分流术治疗门脉高压症

肝硬化门脉高压症(CPH)伴食道、胃底静脉曲张、出血是最严重的并发症之一,也是     

经颈静脉肝内门体分流术的并发症

随着临床应用的深入，经颈静脉肝内门体分流术（ＴＩＰＳ）的并发症，尤其是术后再狭窄和肝性脑病，渐被人们认识。为指导临床稳妥开展ＴＩＰＳ，本按操作顺序，对ＴＩＰＳ术中、术后的相关并发症作一综述。     

经颈静脉肝内门体静脉分流术的回顾与展望

在征服门脉高压所致的严重并发症的道路上 ,过去 10年的进步是历史性的。最引人注目的是非手术方法或微创性介入技术 ,尤其是经颈静脉肝内门体静脉分流术 (ＴＩＰＳ)的10年发展倍受关注。笔者试以所掌握的资料及个人经验对其作一简要的回顾与展望。ＴＩＰＳ的发展196 7年放射学家Ｈａｎａｆｅｅ介绍了经颈静脉及肝静脉达到肝内胆道的造影方法 ,以避免经肝包膜穿刺的出血 ,它对胆道造影本身的影响不大 ,但激发了介入放射学家去用类似的微创技术进入门脉 ,达到门体静脉分流的目的。Ｒｏｅｓｃｈ和Ｈａｎａｆｅｅ先用不同的实验模型建立经颈静…     

经颈静脉肝内门体静脉分流术的并发症

经颈静脉肝内门体静脉支撑架分流术(TIPSS)的并发症及死亡率比外科手术分流的发生率低,但也时有发生。作者复习文献并结合自己的临床资料将并发症按其引起的原因分为以下几类:1.经肝门脉穿刺的并发症;2.体静脉通路引起的并发症;3.门静脉插管及扩张引起     

经颈静脉肝内门体静脉支撑架分流术

一、概况经颈静脉肝内门、体静脉支撑架分流术,又称TIPSS(Transjugular Intrahepatic Portosystemicstent-shunt,以下均称 TIPSS),是一种介入放射学新技术,其基本概念是采用经皮穿刺右侧颈静脉的介入性方法建立肝内的,位于肝静脉及门静脉主要分支之间的分流通道,并以特殊的金属支撑架维持其永久性通畅,达到治疗门脉高压或同时治疗继发的静脉曲张性消化道出血。该技术首先由德国海德堡大学外科医院的 G.M.     

经颈静脉肝内门体静脉分流术术前MRA评价

目的探讨磁共振血管成像（MRA）在经颈静脉肝内门体静脉分流术（TIPS）术前检查中的应用。方法对59例拟行TIPS治疗的患者行术前MRA检查,观察引起门静脉高压的病因、肝静脉及门静脉形态、走行,测量穿刺点处血管管径,并与正常对照组（50例）比较。结果门静脉高压组中单纯肝硬化49例,肝硬化合并肝癌4例,单纯门静脉血栓3例,脾静脉狭窄1例,布-加综合征2例。门静脉高压组与正常对照组肝静脉分型（3支型∶2支型∶1支型）分别为14∶39∶12、12∶34∶14 肝右静脉、肝中静脉、肝左静脉穿刺点管径符合数为52∶40∶28、46∶34∶23。门静脉右支和左支安全穿刺点分别位于（16.2±3.1）mm、（14.2±3.8）mm以远。结论MRA是一种有价值无损伤的检查方法,对TIPS术前疾病诊断及血管定位有着重要的意义。     

经颈静脉肝内门体分流术的初步临床体会

本院自1993年11月至1994年4月用经颈静脉肝内门体分流术(TIPS)收治肝硬化门脉高压患者5例。其中4例穿刺成功,1例失败,1例于术后2月余复发上消化道出血,1例手术后出现一过性肝性脑病症状。门静脉压力从术前35.5±3.3cmH_2O降至术后的24.3±4.5cmH_2O,术后测压显示门腔静脉压力差为8.4±0.7cmH_2O。术后1个月食管钡餐随访,食管静脉曲张均较术前明显改善。作者认为: TIPS操作较外科手术简便,适应证广,降低门脉压力可靠,是治疗肝硬化门脉高压症的有效方法。此外,内支架的选择对防止TIPS术后分流道狭窄有一定作用。     

Usefulness of Transjugular Intrahepatic Portosystemic Shunt in the Management of Bleeding Ectopic Varices in Cirrhotic Patients

Purpose To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the control of bleeding from ectopic varices. Methods From 1995 to 2004, 24 cirrhotic patients, bleeding from ectopic varices, mean age 54.5 years (range 15–76 years), were treated by TIPS. The etiology of cirrhosis was alcoholic in 13 patients and nonalcoholic in 11 patients. The location of the varices was duodenal (n = 5), stomal (n = 8), ileocolic (n = 6), anorectal (n = 3), umbilical (n = 1), and peritoneal (n = 1). Results TIPS controlled the bleeding in all patients and induced a decrease in the portacaval gradient from 19.7 ± 5.4 to 6.4 ± 3.1 mmHg. Postoperative complications included self-limited intra-abdominal bleeding (n = 2), self-limited hemobilia (n = 1), acute thrombosis of the shunt (n = 1), and bile leak treated by a covered stent (n = 1). Median follow-up was 592 days (range 28–2482 days). Rebleeding occurred in 6 patients. In 2 cases rebleeding was observed despite a post-TIPS portacaval gradient lower than 12 mmHg and was controlled by variceal embolization; 1 patient underwent surgical portacaval shunt and never rebled; in 3 patients rebleeding was related to TIPS stenosis and treated with shunt dilatation with addition of a new stent. The cumulative rate of rebleeding was 23% and 31% at 1 and 2 years, respectively. One- and 2-year survival rates were 80% and 76%, respectively. Conclusion The present series demonstrates that bleeding from ectopic varices, a challenging clinical problem, can be managed safely by TIPS placement with low rebleeding and good survival rates.     

Late Intrahepatic Hematoma Complicating Transjugular Intrahepatic Portosystemic Shunt for Budd-Chiari Syndrome

Late intrahepatic hematoma is a rare complication of the transjugular intrahepatic portosystemic shunt (TIPS) procedure. We describe a patient with Budd-Chiari syndrome (BCS) who presented with a large intrahepatic hematoma 13 days after TIPS. Review of the literature revealed only 2 previous cases, both occurring in patients with BCS and presenting after a similar time interval. This potentially serious complication appears to be specific for TIPS in BCS.     

Late Intrahepatic Hematoma Complicating Transjugular Intrahepatic Portosystemic Shunt for Budd-Chiari Syndrome

Late intrahepatic hematoma is a rare complication of the transjugular intrahepatic portosystemic shunt (TIPS) procedure. We describe a patient with Budd-Chiari syndrome (BCS), who presented with a large inrahepatic hematoma 13 days after TIPS. Review of the literature reveals only two previous cases, both occurring in patients with BCS and presenting after a similar time interval. This potentially serious complication appears to be specific for TIPS in BCS.     

多层螺旋CT在TIPSS术后随访中的应用研究

目的:探讨多层螺旋CT血管成像(MSCTA)在TIPSS术后随访中的价值.方法:17例TIPSS术后患者(共19支支架)行MSCT门静脉成像,采用最大密度投影(MIP)、曲面重组(CPR)和容积再现(VR)技术进行图像后处理.17例中6例进行了DSA检查,11例得到了病理标本.将MSCTA表现与病理或DSA结果进行对照分析.结果:MSCTA发现19支支架中完全闭塞3支,支架狭窄4支,肝静脉端狭窄3支,同时伴有支架内和肝静脉端狭窄3支,未见明显异常6支.与DSA或病理对照,CTA诊断支架狭窄的诊断符合率和特异度分别为90%和83.3%,诊断支架闭塞的诊断符合率和特异度分别为100%和94.1%.结论:MSCTA可准确显示TIPSS术后支架的通畅性,为外科提供了一种无创的随访和筛查的手段.     

经颈静脉肝内门腔分流术的临床研究

对ＴＩＰＳＳ的临床应用资料进行分析和总结，评价其近，中期临床应用效果，以寻求进一步提高疗效的途径。材料与方法；分析４０例ＴＩＰＳＳ的临床应用结果，比较及统计了各项术前，术后资料，评价其近，中期疗效。结果；ＴＩＰＳＳ对门脉高压出血有可靠的止血效果。     

Elective Transjugular Intrahepatic Portosystemic Shunt Using Viatorr Stent-Grafts: A Single-Center Experience from China

Background and Aims:Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established approach for the management of variceal bleeding, refractory ascites, hepatic hydrothorax, and preoperative treatment of portal hypertension prior to major abdominal surgery in patients with compensated cirrhosis, and so on. This study aimed to investigate the safety and long-term efficacy of TIPS implantation using Viatorr TIPS stent-grafts.Material and Methods:A cohort of 59 patients undergoing TIPS placement using Viatorr TIPS stent-grafts were included, and the periprocedural events, and long-term mortality, shunt dysfunction, variceal rebleeding and incidence of hepatic encephalopathy (HE) were analyzed.Results:The technical success rate was 100%. The median portosystemic pressure gradient was reduced from 21 mmHg (interquatile range: 19–25) to 13 mmHg (interquatile range: 10–16) before and after TIPS, leading to a hemodynamic success rate of 72.9%. The cumulative rate of overall mortality was 34.2% at five years, and direct bilirubin (hazard ratio [HR] = 1.336, 95% confidence interval [CI]: 1.050–1.700, P = 0.018) and post-TIPS right atrial pressure (HR = 1.238, 95% CI: 1.015–1.510, P = 0.035) were independent predictors for mortality. The cumulative rates of shunt dysfunction and variceal rebleeding were 11.0% and 28.3% at five years, respectively, and portal venous pressure gradient (HR = 2.572, 95% CI: 1.094–6.047, P = 0.030) was the only independent predictor for shunt dysfunction. The cumulative four-year HE-free rate was 48.6%. No severe adverse event was noted during TIPS procedures.Conclusion:Elective TIPS implantation using Viatorr TIPS stent-grafts is generally safe, and the long-term efficacy is favorable for the treatment of cirrhotic patients with recurrent variceal bleeding or refractory ascites.     

Laser Recanalization of a Chronically Occluded Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction is conventionally managed with balloon angioplasty, stent extension, and sharp recanalization when necessary. We describe percutaneous transjugular recanalization and neointimal excision of a chronically occluded 17-year-old TIPS using excimer laser after conventional techniques were unsuccessful. Patient clinical improvement and shunt patency were documented three weeks post-intervention.