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目的 探讨TIPSS技术在治疗门静脉癌栓合并门脉高压中的技术特点及禁忌证。方法16例门静脉癌栓合并门脉高压症患者 ,9例门静脉主干完全堵塞 ,7例门静脉主干及分支有不同程度栓塞 ;6例合并门脉海绵样变 ;1例单纯上消化道大出血 ;4例单纯顽固性腹水 ;11例上消化道大出血合并顽固性腹水。结果 16例中 11例患者成功行TIPSS治疗 ,技术成功率约 6 8.8% ,门脉压力从术前 4.9kPa降至 2 .4kPa ,平均降低 2 .5kPa ,腹水减少或消失 ,症状缓解 ,平均生存 136d。 5例失败。结论 TIPSS是治疗门脉癌栓引起的上消化道大出血和顽固性腹水的有效方法 ,门脉海绵样变是该术的禁忌证。
Objective To investigate the technical characteristics and contraindications of TIPSS in the treatment of portal vein tumor thrombus with portal hypertension. Methods Sixteen patients with portal vein tumor thrombus and portal hypertension were involved in this study. Nine cases of portal vein occlusion were completely blocked, seven cases of portal vein trunk and branches were embolized with different degrees of embolism, six cases of portal vein cavernous transformation, one case of simple upper gastrointestinal bleeding, four cases Simple refractory ascites; 11 cases of upper gastrointestinal bleeding with intractable ascites. Results Of the 16 patients, 11 patients successfully treated with TIPSS, the technical success rate of about 6 8.8%, portal pressure decreased from 4.9kPa preoperative 2.4kPa, an average reduction of 2.5kPa, ascites decreased or disappeared, symptoms were relieved, the average survival 136d. 5 cases failed. Conclusion TIPSS is an effective method for treating upper gastrointestinal bleeding and intractable ascites caused by portal vein thrombosis. Portal vein sponge-like change is a contraindication to this technique.