Objective: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS) for the treatment of patients with cavernous transformation of portal vein (CTPV) with vareceal bleeding. Methods: From September 2016 to June 2018, a total of 21 patients suffered CTPV complicated with vareceal bleeding were admitted to First Affiliated Hospital of Zhengzhou University. TIPS were performed combined with percutaneous transhepatic portal vein assist. There were 13 males and 8 females, with an average age of 27-67 (48±11) years. Blood routine examination, liver function test, blood ammonia and ultrasound Doppler were conducted 1,3,6 months after operation, and every 6 months during follow-up. Abdominal enhanced CT and digital substraction angiography were followed every year. Results: TIPS were successfully performed in 19 cases (90.5%), esophageal and gastric varices were embolized in 17 cases; 2 cases failed to selective catheterized, then endoscopic therapy was performed.All bleeding stopped after operation. The pressure of portal vein decreased from 25.0-44.0 (33.7±5.4) mmHg (1 mmHg=0.133 kPa) to 17.0-30.0 (24.5±3.1) mmHg, portosystemic pressure gradient decreased from 16.0-32.0 (23.5±4.6) mmHg to 9.0-15.0 (11.4±1.9) mmHg after TIPS (all P<0.05). During 3-24 months follow-up, 2 patients suffered from hepatic encephalopathy, 3 patients had recurrent upper gastrointestinal bleeding, including 1 duodenal ulcer and 2 esophageal varices. In-stent restenosis were found in 6 patients,in which 3 patients underwent shunt revision operation. At the end of the follow-up, the cumulative patency was 16/19. Conclusion: For patients with CTPV and vareceal bleeding, TIPS could reduce portal hypertension while embolizing varicose veins.It is a safe and effective treatment.
目的： 探讨经颈静脉肝内门体分流术（TIPS）治疗门静脉海绵样变合并食管胃底静脉出血的疗效。 方法： 回顾性分析2016年9月至2018年6月郑州大学第一附属医院21例门静脉海绵样变合并上消化道出血患者临床资料。21例患者均行TIPS手术，其中男13例、女8例，年龄27~67（48±11）岁。术后1、3、6个月，之后每隔6个月复查血常规、肝功能、血氨及超声，每年行上腹部增强CT及分流道造影。 结果： 19例患者（90.5%）成功行TIPS术，17例栓塞曲张静脉，2例无法超选栓塞，二期行胃镜下治疗，术后患者均出血停止。门静脉压力由术前的25.0~44.0（33.7±5.4）mmHg（1 mmHg=0.133 kPa）降低至17.0~30.0（24.5±3.1）mmHg，门静脉压力梯度由16.0~32.0（23.5±4.6）mmHg降低至9.0~15.0（11.4±1.9）mmHg，差异均有统计学意义（均P<0.05）。随访3~24个月，19例成功接受TIPS患者2例出现二期肝性脑病，再发上消化道出血3例，其中1例为十二指肠溃疡，2例为食管静脉曲张所致。支架内再狭窄率6例，其中3例行修正术，随访期末16/19的二期通畅率。 结论： 对于门静脉海绵样变合并上消化道出血的患者，TIPS栓塞曲张静脉的同时降低门静脉压力，是一种安全、有效的方法。.
Keywords: Esophageal and gastric varices; Portasystemic shunt, transjugular intrahepatic; Radiology, interventional.