You Position: Home > Paper
The clinical choice in the method of interventional treatment to portal hypertension
( views:62, downloads:129 )
- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF RADIOLOGY
- Issue:
- 10
- DOI:
- 10.3760/j.issn:1005-1201.2004.10.002
- Key Word:
- 门静脉,高血压;门体分流;曲张静脉;栓塞,治疗性
Abstract： 目的探讨在不同条件下选择合理治疗门静脉高压症的介入方式.方法回顾分析1997～2002年5年间介入治疗的76例门静脉高压症患者.经颈内静脉肝内门体分流术(TIPSS)治疗26例,其中11例为外科断流后再出血,6例为胃镜套扎后再出血,余9例为内科保守治疗无效且无外科或胃镜套扎治疗史者.经皮经肝食管胃曲张静脉栓塞术(PTVE)联合部分性脾栓塞(PSE)治疗50例,50例患者均为内科保守治疗无效者.所有76例患者于治疗前后均测量自由门静脉压(FPP),术前均由螺旋CT测量肝脏体积并于治疗1年后复查.结果 TIPSS治疗组与PTVE联合PSE治疗组中门静脉压分别由术前(3.85±0.42)kPa(1 kPa = 7.5 mm Hg)下降至术后(3.09±0.44)kPa(P<0.01), (3.79±0.51)kPa降至术后(3.28±0.57) kPa,(P<0.01).两组术后1年再出血率分别为0%,4%,肝性脑病发生率为19.2%(5/26),2.0%(1/50).TIPSS组术后肝脏体积明显缩小而PTVE联合 PSE组无明显改变.肝脏体积小于700 cm3与大于700 cm3者相比,TIPSS治疗后肝性脑病发生率明显增高﹙P<0.05).脾功能亢进均有效控制.结论门静脉高压症介入治疗的2种方式各有长短,应根据具体情况加以选择; 肝脏体积是评估及选择治疗方式的重要因素.
- [1]罗剑钧,颜志平,周康荣,等.六例直接性门腔静脉分流术的初步经验[J].2004,(1).
- [2]李征然,单鸿,朱康顺,等.部分性脾栓塞术改变门脉血流动力学的定量研究[J].2002,(10).
- [3]申麒,蒋忠仆,邢坚强,等.门静脉高压症介入断流术前后血液动力学的改变及临床意义[J].2002,(12).
- [4]杨建勇.经颈静脉肝内门体静脉分流术的回顾与展望[J].2000,(12).
- [5]Kwang-Hun, Lee,Do-Yun, Lee,Jong-Yoon, Won,etc.Transcaval transjugular intrahepatic portosystemic shunt: preliminary clinical results.[J].1900,4.
- [6]E J, Evanson,J, McIvor,I M, Murray-Lyon,etc.Survival after transhepatic embolization of gastro-oesophageal varices.[J].1991,44.
- [7]张金山,王茂强,杨立,等.经颈静脉肝内门腔静脉内支架分流术的临床应用（附86例随访分析）[J].1994,(12).
- [8]徐克,张曦彤,张汉国,等.TIPSS治疗肝硬化门脉高压的应用研究[J].1994,(12).
- [9]Uchida BT,Timmermans H,Rosch J,etc.Intravascular US-guided direct intrahepatic portacaval shunt with a PTFE-covered stent-graft: feasibility study in swine and initial clinical results.[J].2001,12(4).
- [10]G, Smith-Laing,J, Scott,R G, Long,etc.Role of percutaneous transhepatic obliteration of varices in the management of hemorrhage from gastroesophageal varices.[J].1981,80.
- [11]刘福全,王淑霞,殷其潭,等.双介入栓塞治疗门静脉高压食管、胃底曲张静脉出血及脾功能亢进[J].1995,(11).
- [12]K G, Benner,E B, Keeffe,F S, Keller,etc.Clinical outcome after percutaneous transhepatic obliteration of esophageal varices.[J].1983,85.
- [13]J M LaBerge,E J Ring,R L Gordon,etc.Creation of transjugular intrahepatic portosystemic shunts with the wallstent endoprosthesis: results in 100 patients.[J].1993,187(2).
- [14]Une Y,Nakajima Y,Uchino J,etc.The significance of measuring liver volume using computed tomographic images before and after hepatectomy.[J].1995,25(1).
- [15]吴阶平，裘法祖主编.黄家驷外科学[M].2000.
- [16]I, Albers,H, Hartmann,J, Bircher,etc.Superiority of the Child-Pugh classification to quantitative liver function tests for assessing prognosis of liver cirrhosis.[J].1989,24.
- [17]G M, Richter,J C, Palmaz,G, N?ldge,etc.[The transjugular intrahepatic portosystemic stent-shunt. A new nonsurgical percutaneous method].[J].1989,29(8).