急诊经颈静脉途径肝内门体分流术（附12例报告）

报告１２例急诊经颈静脉途径肝内门体分流术，旨在评价临床疗效及探讨急诊情况下的有关治疗技术问题。１２例中男性患者１０例，女性２例，年龄４２～７２岁，均为其他保守治疗方法所不能控制的食管胃静脉曲张破裂大出血患者，１０例在三腔双囊管压迫下行ＴＩＰＳＳ。结果：１１例穿刺门脉成功并建立起有效分流，１例因门脉海绵状变性而终止分流术；除１例未能控制大出血（与选择栓塞剂不当有关）、于术后１．５小时死亡外，其余技术成功的病例均获得优良的止血效果。初步结论：ＴＩＰＳＳ对于其他方法所不能控制的静脉曲张破裂大出血患者是一有效的救治措施。为及时控制出血，作者推荐常规用钢丝圈栓塞曲张的静脉。

Emergency Transjugular Intrahepatic Portosystemic Stent Shunt for Control of Acute Massive Variceal Bleeding : Results in 12 Patients

To evaluate the efficacy of the transjugular intrahepatic portosystemic stent shunt (TIPSS) in treatment of acute massive variceal hemorrhage, 12 cases were retrospectively analyzed. The patients consisted of 10 men and 2 women, ranged in age from 42 to 74 years. All patient had life-threatening variceal bleeding and failed pharmacological measures and endoscopic sclerotherapy, ten of them underwent the procedures under the balloon tamponade. The results showed that shunt were established in 11 of 12 patients, one failed because of the portal vein with cavernous transformation. Bleeding was controlled in ten cases. One patient died of recurrent massive bleeding 1.5 hours after the shunt, which was related to the improper embolic material. The results indicated that TIPSS can be life saving and is effective in controlling acute variceal blee-ding unresponsive to the conservative therapy. To stop the bleeding immediately, the varices should be routinely embolized with metallic coils.