探讨经颈内静脉肝内门腔静脉分流术(TIPSS)治疗老年肝硬化门静脉高压症的疗效。

2008年1月至2014年6月福建医科大学附属协和医院选取老年肝硬化门静脉高压症患者119例，均经内科治疗无效后择期行TIPSS治疗。术后随访24个月，观察记录患者手术前后的门静脉压力，以及术后3，6，12，24个月再出血发生情况、腹水治疗情况、分流道狭窄发生情况。手术前后门静脉压力比较采用配对t检验，发生率的比较采用χ²检验。

所有患者均成功置入支架建立分流道，其中75例采用Fluency覆膜支架，44例采用金属裸支架。患者TIPSS前后门静脉压力分别为(35.00±6.55)cmH₂O及(20.92±6.63) cmH₂O，差异有统计学意义(t＝13.43，P<0.01)。术后3，6，12，24个月，36例顽固性腹水患者TIPSS后腹水完全缓解及部分缓解率分别为82.35%，84.85%，85.19%，76.00%；91例食管胃底静脉曲张破裂出血患者再出血发生率分别为5.49%，12.94%，22.72%，33.33%；119例患者分流道狭窄发生率分别为4.27%，10.00%，14.28%，24.19%。随访24个月，裸支架组狭窄率为47.73%，覆膜支架组狭窄率为17.33%，差异有统计学意义(χ²＝12.55，P<0.01)。

TIPSS具有疗效好、创伤小、操作时间短、并发症少、肝功能损害轻等优点，是老年肝硬化门静脉高压症的有效治疗手段；术中应用覆膜支架可能会明显降低支架狭窄发生率。

To evaluate the effect of transjuaular intrahepatic portosystemic stent shunt (TIPSS) in the treatment of senile cirrhosis and portal hypertension.

A retrospective analysis was reviewed on the 119 elder patients with senile cirrhosis and esophageal varices bleeding and refractory ascites. All of them underwent TIPSS after medical treatment fails. They were strictly followed up for 2 years and their clinical data were analysed. Color doppler imaging and shunt angiography were used to follow up patients to analyze the cases and type of stenosis.

All patients were successfully implanted with stents (75 cases with the fluency stents, 44 cases with bare-metal stents)to establish shunt. Portal venous pressure from before TIPSS (35.00±6.55) cmH₂O to after TIPSS (20.92±6.63) cmH₂O(t=13.43, P<0.01). There is a significant difference. TIPSS after 3 months, 6 months, 12 months and 24 months ascites complete or partial remission rates were 82.35%, 84.85%, 85.19% and 76.00%, rebleeding rates were 5.49%, 12.94%, 22.72% and 33.33%, incidence of shunt stenosis were 4.27%, 10.00%, 14.28% and 24.19%. After 2-year follow-up, the bare stent group had 47.73% stenosis; the covered stent group had 17.33% (χ²=12.55, P<0.01). The difference between two groups was statistically significant.

TIPSS is available and satisfactory in the treatment of senile cirrhosis and portal hypertension, which has high efficacy. TIPSS is less invasive, takes shorter operation tim, causes fewer complications. Stenosis rate can be significantly decreased by the application of covered stent in TIPSS.