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目的：评价经颈静脉肝内门体静脉分流术对肝硬化门脉高压症的疗效及优缺点。方法：先行预造影，经颈静脉插管至肝静脉，在肝内从肝静脉向门静脉穿刺，穿刺成功后选择性行胃冠状静脉栓塞，然后行球囊导管扩张建立分流通道，放置支架。结果：共２５例病例，２１例成功，４例失败。门脉压力从术前４０２±０３９ｋｐａ降至术后２５８±０２３ｋｐａ（Ｐ＜００１），门脉主干由１３４±０２４ｃｍ降至１１４±０２１ｃｍ（Ｐ＜００５），门脉主干血流速度由术前２３０±６５ｃｍ／ｓ增至术后４５５±１２３ｃｍ／ｓ（Ｐ＜００５），脾脏长径由１５８５±１７９ｃｍ缩小为１３８５±１８０ｃｍ（Ｐ＜００５）。食管静脉曲张消失１４例，明显减轻７例，６例伴顽固性腹水者术后明显减少。术后随访３～１５个月（平均１０个月），随访期间５例发生肝性脑病，３例分流通道发生明显狭窄（内径缩小０３ｃｍ以上），再出血及再发顽固性腹水各一例。结论：ＴＩＰＳＳ对迅速缓解门脉高压症，解除出血危险性是一种比较好的方法，近期疗效满意。但术后肝性脑病和分流通道发生狭窄值得重视。
Objective: To evaluate the efficacy and advantages and disadvantages of transjugular intrahepatic portosystemic shunt on liver cirrhosis and portal hypertension. Methods: The first pre-angiography was performed through the jugular vein to the hepatic vein. The hepatic vein was punctured from the hepatic vein to the portal vein. After successful puncture, gastric bypass was selectively performed. Then the balloon catheter was expanded to establish a shunt channel and the stent was placed. Results: A total of 25 cases, 21 cases were successful, 4 cases failed. Portal pressure decreased from 402 ± 039kpa to 258 ± 023kpa (P00101), and the main portal vein decreased from 134 ± 024cm to 114 ± 0 (P <005). The portal blood flow velocity increased from 230 ± 6.5 cm / s to 455 ± 123 cm / s (P <005) The long diameter reduced from 1585 ± 179cm to 1385 ± 180cm (P <005). Esophageal varices disappeared in 14 cases, significantly reduced in 7 cases, 6 cases with refractory ascites were significantly reduced after surgery. All cases were followed up for 3-15 months (average 10 months). Hepatic encephalopathy was observed in 5 cases during follow-up. Three cases had obvious narrowing of shunt channels (diameter of 03 cm or more), one case of rebleeding and refractory ascites . Conclusion: TIPSS is a good way to relieve portal hypertension and relieve the risk of bleeding, and the effect is satisfactory in the near future. However, postoperative hepatic encephalopathy and shunt narrowing deserves attention.