CAJ | 학술논문

目的探讨门静脉高压症患者在肠腔分流术(肠系膜上静脉-下腔静脉人工血管反“C”形搭桥术)后人工血管分流道狭窄或者闭塞的原因,分析经皮穿刺介入治疗的可行性并观察疗效.方法回顾性分析郑州大学第一附属医院2009年3月至2012年3月对门静脉高压症患者行肠腔分流术后人工血管分流道狭窄或闭塞19例患者的临床资料.结果本组19例门静脉高压症肠腔分流术后分流道狭窄或闭塞的患者中,5例为术后1周内分流道急性血栓形成,均给予介入置管接触溶栓术；6例为术后1～8年出现分流道狭窄,均为人工血管-肠系膜上静脉吻合口狭窄,给予球囊扩张或(和)支架成形；8例为术后1～4年出现分流道闭塞,成功开通6例,给予球囊扩张或(和)支架成形,失败2例,均为导丝导管无法通过人工血管-下腔静脉吻合口.同期行胃冠状静脉或(和)胃短静脉栓塞者11例,以利于术后标准抗凝.治疗成功病例在术后症状改善明显.随访3个月至3年,1例肠腔分流道狭窄患者在单纯球囊扩张后1年症状复发,彩超显示肠腔分流道狭窄,给予分流道支架成形术后,随访5个月无复发；其余患者症状未复发.结论应用经皮穿刺通过“股静脉-下腔静脉-人工血管-门静脉”途径介入治疗(置管接触溶栓治疗、球囊扩张、支架置入等)肠腔分流术后分流道狭窄或闭塞患者创伤小,成功率高,疗效显著.
목적 탐토문정맥고압증환자재장강분류술(장계막상정맥-하강정맥인공혈관반“C”형탑교술)후인공혈관분류도협착혹자폐새적원인,분석경피천자개입치료적가행성병관찰료효.방법 회고성분석정주대학제일부속의원2009년3월지2012년3월대문정맥고압증환자행장강분류술후인공혈관분류도협착혹폐새19례환자적림상자료.결과 본조19례문정맥고압증장강분류술후분류도협착혹폐새적환자중,5례위술후1주내분류도급성혈전형성,균급여개입치관접촉용전술；6례위술후1～8년출현분류도협착,균위인공혈관-장계막상정맥문합구협착,급여구낭확장혹(화)지가성형；8례위술후1～4년출현분류도폐새,성공개통6례,급여구낭확장혹(화)지가성형,실패2례,균위도사도관무법통과인공혈관-하강정맥문합구.동기행위관상정맥혹(화)위단정맥전새자11례,이리우술후표준항응.치료성공병례재술후증상개선명현.수방3개월지3년,1례장강분류도협착환자재단순구낭확장후1년증상복발,채초현시장강분류도협착,급여분류도지가성형술후,수방5개월무복발；기여환자증상미복발.결론 응용경피천자통과“고정맥-하강정맥-인공혈관-문정맥”도경개입치료(치관접촉용전치료、구낭확장、지가치입등)장강분류술후분류도협착혹폐새환자창상소,성공솔고,료효현저.
Objective To evaluate interventional therapy in the treatment of interposition graft stenosis or occlusion after mesocaval shunts.Methods The clinical data of 19 cases of artificial vessel stenosis or occlusion after mesocaval shunts for portal hypertension at our department from march 2009 to march 2012 were retrospectively analyzed.Results In the 19 cases with artificial vessels stenosis or occlusion developed after mesocaval interposition shunts for portal hypertension,there were 5 cases in which acute thrombosis occurred within a week after the surgery.Catheter directed thrombolysis was successfully conducted.In 6 cases in which shunt stenosis developing 1 to 8 years after surgery were managed by balloon dilatation or stent angioplasty successfully.The shunt graft occlusion occurred in 8 cases after 1 to 4 years of surgery was successfully managed and the shunt was reopened by balloon dilatation or stent angioplasty in 6 cases,and in 2 the procedure was failed for the guide wire can't go through the anastomotic site of artificial vessel-superior mesenteric vein.In 11 cases embolization of the esophagogastric varices was successfully carried out for postoperative standard anticoagulation.During a period of 3 months to 3 years follow-up,stenosis recurred 1 year after balloon dilatation in one case,and stenosis was managed by angioplasty successfully.Conclusions Interventional radiological techniques by percutaneous puncture through "femoral vein-inferior vena cava-artificial vessel-portal vein" (including catheter directed thrombolysis,balloon dilatation,stent placement,etc) are less traumatic,highly successful in the treatment of shunt stenosis or occlusion after mesocaval shunts in portal hypertension.