经颈静脉肝内门体分流术(TIPS).ppt

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style,第,*,页,第,*,页,第,*,页,第,*,页,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,第,*,页,第,*,页,第,*,页,第,*,页,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,第,*,页,第,*,页,第,*,页,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,.,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,.,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,.,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,.,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,.,*,经颈静脉肝内门体分流术（,TIPS),南通市肿瘤医院介入科,2016,年新开展项目,1,.,肝脏肿瘤通过介入手段能够很好的控制，肝硬化导致的腹水、反复上消化道出血、肝肾综合征等却夺去了患者的生命。,？,2,.,经颈静脉肝内门体静脉内支架分流术,(TIPSS),原理、结构,原 理,采用,特殊,的介入治疗器械，在,X,线透视,导引下，经颈静脉入路，建立肝内的位于,肝静脉及门静脉主要分支之间的人工分流通道,，并以,金属内支架,维持其永久性通畅，达到,降低门脉高压,后,控制,和,预防食道胃底静脉曲张破裂出血,，,促进腹水吸收,。,TIPSS:transjugular intrahepatic portosystem stent-shunt.,3,.,适应症,食管、胃底静脉曲张破裂大出血，经保守治疗效果不佳者；,中,-,度食管、胃底静脉曲张，随时有破裂出血危险者；,门脉高压所致的顽固性腹水；,肝硬化并发肾功能不良者,。,经颈静脉肝内门体静脉内支架分流术,(TIPSS),适应症及扩展,适应证扩展,不必考虑有无硬化治疗的病史；,难治性腹水如肾功能尚可,TIPS,后可获,90%,的疗效等待肝移植期间；,小儿门脉高压,(,优于内窥镜治疗,),；,门脉高压合并脾功能亢进。,4,.,经颈静脉肝内门体静脉内支架分流术,(TIPSS),原理、结构,Hepatic vein,肝静脉,Shunt,分流器,Portal vein,门静脉,Liver 肝脏,Spleen 脾脏,选择,肝静脉,与,门静脉主干中距离最近,的两支，,一般肝右或肝中与门脉右支,，穿刺成功后将导丝插入球囊扩张导管，将通道扩张至,8,12mm,，置入网状支架，,要求,支架能覆盖全通道。,5,.,经颈静脉肝内门体静脉内支架分流术,(TIPSS),效果、优点、缺点,经过,4,7,天后，,部分肝硬化患者,肝功能得到改善，,腹水减轻或消失,，内镜检查食管胃底静脉曲张大为,减轻或消失,。,技术可行,、,疗效确切,、,创伤小,、,分流和断流并举,的优点,。,肝硬化肝内,网状支架易脱落,，建立的,通道也易于阻塞,，反复肝穿易导致肝内动,-,静脉瘘门脉系统,血栓形成,，继发,腹腔大出血,等并发症缺点。,优点,缺点,效果,6,.,禁忌症,肝功能不全，严重黄疸,(,血清胆红质,855p,mol/L),不适宜行肝移植者；,肝性脑病在,级以上；,心肺功能不全；,凝血机制障碍；,颈内静脉、腔静脉血栓性闭塞，门静脉海绵窦样形成；,肝动脉灌注不足或有明显的腹腔动脉干及肝动脉狭窄或阻塞者；,肝内大血管周围的肿瘤。,经颈静脉肝内门体静脉内支架分流术,(TIPSS),禁忌症,7,.,经颈静脉肝内门体静脉内支架分流术,(TIPSS),操作步骤,8,.,经颈静脉肝内门体静脉内支架分流术,(TIPSS),操作过程,9,.,经颈静脉肝内门体静脉内支架分流术,(TIPSS),操作步骤,10,.,经颈静脉肝内门体静脉内支架分流术,(TIPSS),操作步骤,11,.,经颈静脉肝内门体静脉内支架分流术,(TIPSS),操作步骤,12,.,经颈静脉肝内门体静脉内支架分流术,(TIPSS),操作步骤,13,.,经颈静脉肝内门体静脉内支架分流术,(TIPSS),分流前后对比,14,.,经颈静脉肝内门体静脉内支架分流术,(TIPSS),出院指导,定期到医院检查,分流通道通畅情况，如出现呕血、黑便、腹胀等情况立即到医院就诊；,强调,勿暴饮暴食,，摄入低蛋白饮食，避免进坚硬、辛辣食物，戒烟酒；,避免精神紧张，生活规律、劳逸结合，,保证充足的睡眠和休息,；,坚持,按时服用药物,，,定期复查,肝肾功能、血氨、肝脏彩超、胃镜等，一般在术后,1,个月、,3,个月、半年、,1,年各检查,1,次。,出院指导,15,.,谢谢！,16,.,