目的 探讨开窗技术建立Y形通道治疗经颈静脉肝内门体分流术(TIPS)后支架分流道梗阻的可行性.方法 2012年2月至2016年12月采用穿刺支架开窗梗阻建立Y形通道治疗7例支架分流道梗阻伴复发性门静脉高压所致胃底静脉曲张出血或腹水患者.术前肝功能Child-Pugh评分5～10分,平均(6.85±1.56)分.对比术前与术后5d、术后1、3、6个月门静脉和分流道内血流情况.结果 7例患者均成功重建Y形通道.平均随访11个月,无一例死亡,未发生肝性脑病.结论 梗阻支架内Y形开窗重建治疗TIPS术后支架分流道梗阻安全有效、操作方便,具有一定的临床价值.%Objective To discuss the feasibility of the establishment of a Y-shaped channel with windowing technique in treating the stent shunt obstruction occurring after transjugular intrahepatic portosystemic shunt (TIPS).Methods From February 2012 to December 2016,puncture windowing technique was employed in 7 patients to establish a Y-shaped channel in order to treat the stent shunt obstruction complicated by gastric varices bleeding or ascites due to recurrent portal hypertension.The preoperative Child-Pugh scores of liver function ranged from 5 to 10 points,with a mean of (6.85±1.56) points.The blood flow in both the portal vein and the shunt was determined before operation as well as at 5 days and 1,3,6months after operation;the post operative results were compared with preoperative ones.Results Y-shaped channel was successfully reconstructed in all 7 patients.The patients were followed up for a mean of 11months.Neither death nor hepatic encephalopathy occurred.Conclusion For the treatment of post-TIPS stent shunt obstruction,Y-shaped channel reconstruction within the occluded stent by using windowing technique is safe and effective,the operation is simple and easy.Therefore,this technique has certain clinical value.
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