摘要
目的介绍一种全新肝内分流支架的结构和在经皮经肝肝内门腔静脉分流术(PTPS)中应用的临床结果。分析应用该支架建立的门腔静脉分流道与经典TIPS所用支架血流动力学之间的差异,探讨其潜在的临床意义。方法38例门静脉高压症患者采用预应力支架行PTPS。其中静脉曲张出血36例,难治性腹水1例及肝肺综合征1例；肝功能Child Pugh B级27例、C级11例。经皮经肝穿刺进入门静脉右支,再经门静脉左支矢状部穿刺肝段下腔静脉,经皮经肝植入预应力支架于门静脉左支与肝段下腔静脉之间。结果38例采用预应力支架行PTPS均获成功,技术成功率100%,术中未出现与技术相关并发症,术后门腔压力梯度平均下降14 cmH_2O,平均随访493 d,所有患者未发生再出血,难治性腹水得到有效地控制。初步开通率达98．9%。结论采用预应力支架经皮经肝途径建立门腔静脉分流安全可行,其血流动力学结果提示预应力支架形态及与相关血管壁间“吻合”严密,符合正常肝内门静脉血流动力学分布,既起到门静脉部分性降压作用,又保障了门静脉右支血流的肝内灌注,对术后预防分流道再狭窄及降低肝内分流术后肝性脑病发生率具有重要的临床意义。
Objective To present a preliminary latest procedure for portal hypertension and evaluate the technical feasibility and efficacy of portacaval shunt creation through the percutaneous transhepatic approach in order to make a hemodynamic comparison with that of the classic TIPS. Methods Thirty-eight patients with portal hypertension（36 men; mean age 57 years, range 32 - 73）were referred for PTPS procedure because of bleeding varices（n = 36）, intractable ascites（n = 1 ）, and hepatopulmonary syndrome（n = 1 ）. The severity of liver disease was classified as Child-Pugh B in 27 and C in 11. The PTPS was created by a percutaneous transhepatic puncture into fight portal vein and then through left portal vein to the hepatic segment of IVC followed by a prefabrication stress stent-graft placement at the very site. Results Technical and functional success of 100% was achieved in all patients, without related complications. The postprocedural portal vein-IVC gradients mean 13 cmH2O was achieved with the follow-up period mean 493 days. No recurrence of variceal bleeding and controlled refractory ascites were achieved, and still more with primary patency rate of the involved vascular structure up to 94.8% at 365 days, much better than classic TIPS. Conclusions Portacaval shunt creation using the prefabrication stress stent via percutaneous transhepatic technique is safe and feasible. The compact coincidence was obtained between the stent and the involved vessel with restoration of intrahepatic portal venous hemodynamics together with partial lowering of portal venous pressure and guaranteeing intrahepatic perfusion through fight portal vein. It is also obviously to have postoperative prevention of shunt restenoses and lowering postoperative incidence of hepato-encephalopathy.
出处
《介入放射学杂志》
CSCD
2006年第11期652-655,共4页
Journal of Interventional Radiology
关键词
高血压
门静脉
门腔静脉分流
经皮经肝
预应力
血流动力学
Hypertension,portal
Portacaval shunts interventional procedures
Percutaneous transhepatlc
Prefabrication stress
Hemodynamics
