|
Long-term outcome following transjugular intrahepatic portosystemic shunt for variceal bleeding due to portal hypertension
【Abstract】 Objective To study the 6-year outcome following transjugular intrahepatic portosystemicshunt (TIPSS) for variceal bleeding due to portal hypertension.
Methods 65 patients, 51 males, 14 females,aged 35~72 years old with averaged 4.5 years, have been undergone TIPSS because of portal hypertension due to cirrhosis or Budd-Chiari syndrome. The portal pressures were measured before and after TIPSS. Follow-up study was done by color Doppler sonography or Barium esophageal radiogaphy for 3 months to 6 years (averaged 18 months). Repeated interventional treatments were done in cases of restenosis of the shunts.
Results There were 0,2,10,5,0 cases of recurrent bleeding after 3 months, 6 months, 1 year, 2 year and 3—6 year following TIPSS respectively. Stenosis occurred in shunt paths due to thrombosis or smooth muscle cell proliferation or neointimal hyperplasia were relieved after thrombolytic therapy and repeated balloon angioplasty or stent plant among most of them. 2 were failed due to serious stenosis. 7 cases died, 2 of massive bleeding,1 of the other cause and 4 of hepatic cancer. The other patients are getting well.
Conclusions Although there were very high rates of restenosis (34%), but most of them could be treated again with interventional therapy, and in kept patency effectively. TIPSS is a still practical valuable management for massive gastric bleeding.
【Key words】 Transjugular intrahepatic portosystemic shunt; Portal hypertension; Stenosis; Massive gastric bleeding
经颈静脉肝内门体静脉分流术(Transjugular intrahepatic porto-systemic stent shunt, TIPSS)于1991年由德国Richter首次成功地用于临床,随后这一新技术在许多国家得到迅速发展[1]。我国于1992年应用于临床,迄今为止,共施行TIPSS 700余例,但这一数字仅包括正式见于期刊或会议报道的病例。TIPSS这一技术由最初的火热到最近几年的冷淡,究其原因主要是分流道再狭窄率较高。我院是国内开展TIPSS较早的单位之一,我们报道最长随访6年多的一组病例,并探讨其疗效及经验。
资料与方法
一、一般资料
1993年2月~2000年11月对65例肝硬化和Budd-Chiari综合征患者进行TIPSS治疗。65例中男51例,女14例。年龄35~72岁,平均45岁。病程1~10年不等,55例有1次以上呕血或黑便病史,其中42例曾接受1次以上经内镜注射硬化剂治疗,8例曾行脾切除及外科分、断流术,3例为急性大出血,经内镜注射硬化剂及三腔两囊管压迫后仍出血不止而行急诊TIPSS,2例为Budd-Chiari综合征,因肝静脉广泛狭窄而行经下腔静脉门静脉TIPSS分流术。
钡餐和内镜检查发现,食管胃底重度静脉曲张48例,中度曲张17例,B超、CT影像学检查均提示肝硬化、门脉高压,20例有少量或中等腹水。实验室检查:脾功能亢进28例,白细胞计数(3.4~9.0)×109/L(平均6.0×109/L),血小板(21~79)×109/L(平均34×109/L)。7例ALT及AST轻度增高,血清总胆红素轻度增高3例,低白蛋白血症12例(血清白蛋白21~38g/L)。出、凝血时间均在正常范围。肝功能分级:Child A级43例,B级15例,C级7例。
|
