Transjugular intrahepatic portosystemic shunt ; Experimental and clinical study

实验研究：采用猪急性门静脉窦前高压症实验模型，研究经颈静脉肝内门静脉系统分流z型支架的可溶性及分流尺寸与门静脉压力降低程度的关系。使用了12头小猪。在肝内门静脉分支选择性注射无水乙醇、乙硫酚和依瓦隆引起急性门静脉高压症。使用z -支架在4只猪中分别成功制备了直径为6、8和10mm的TIPS。由于具有足够的灵活性，z型支架可以适应弯曲的分流轨道。6mm直径支架的门静脉压力平均降低48%，8mm直径支架的门静脉压力平均降低64%，10mm直径支架的门静脉压力平均降低89%。这些结果与我们使用Gianturuco-Rosch z型支架形成TIPS的临床经验一致。临床研究：在9例肝癌患者中建立TIPS （Child class A=3， B=2， C=4）。9例患者中有7例采用栓塞治疗和/或经皮注射乙醇治疗，治疗效果良好。技术成功率为100%，无手术相关并发症。30天死亡率为0%。TIPS成功后5例静脉曲张出血均立即停止，无法控制的腹水3例消失，2例无变化。TIPS是治疗静脉曲张出血和腹水的一种安全有效的门静脉减压方法，即使对肝癌患者也是如此。

Experimental study : An experimental swine model with acute presinusoidal portal hypertension was used to investigate the fisibility of a Z-stent for transjugular intrahepatic portosystemic shunt and the correlation between the shunt size and degree of portal pressure decrease. Twelve young swine were used. Acute portal hypertension was indused by selective injections of absolute ethanol, Ethiodol, and Ivalon into intrahepatic portal branches. TIPS was successfully created in all swineusing Z-stent, 6,8, and 10mm in deameter, each size in 4 animals. Being sufficiently flexible, Z-stents accommodated for curved shunt tracks. An average of 48% portal pressure decrease was achieved with 6mm diameter stents, 64% with 8 mm diameter stents and 89% with 10 mm diameter stents. These results are in agreement with our clinical experience using Gianturuco-Rosch Z-stents for TIPS formation.Clinical study : TIPS was created in nine patients with hepatoma (Child class A=3, B=2, C=4). 7 of 9 patients had been treated hepatomas by embolotherapy and/or percutaneous ethanol injection, whic were well controlled. Technical success was 100% without procedure-related complication. Thirty-day mortality rate was 0%.All of 5 variceal hemorrhage arrested immediately after successful of TIPS,and uncontrollable ascites was dissapeared in 3 and no change in 2. TIPS creation is a safe and effective method of portal venous decompression in the management of variceal bleeding and ascites even for the patients with hepatoma.