CAJ | 학술논문

目的介绍一种经皮经肝途径建立肝内门体分流道的新方法,评价其安全性和可行性,探讨其潜在的临床意义.方法 2009年11月至2011年1月,中山大学附属第三医院介入血管科8例复杂门静脉高压患者行经皮经肝穿刺肝内门体分流术.术前肝功能Child-Pugh A级2例,B级3例,C级3例.经皮成功穿刺肝内门静脉后,沿同一穿刺道经门静脉穿刺肝段下腔静脉(或肝静脉),建立肝内门体分流道.结果 8例患者经皮经肝门体分流术均获得成功.术后门静脉压力由术前(31.0±4.3) mm Hg降至(18.9±2.7) mm Hg(t 10.258,P＜0.01).1例术后5d因肝功能衰竭死亡；其余7例存活患者随访2 ～ 20个月,中位随访时间9个月.1例门静脉系统弥漫血栓患者,4个月后分流道闭塞；1例顽固性腹水患者2个月后腹胀症状复发,再次置入支架后腹水肖失；余5例随访期间未再发出血,伴随的腹水症状消失.结论经皮经肝穿刺肝内门体分流术为复杂门脉高压症患者的肝内门体分流提供了一种安全、有效的治疗方法,手术成功率高,是常规经颈静脉肝内门体分流术的有效补充.
목적 개소일충경피경간도경건립간내문체분류도적신방법,평개기안전성화가행성,탐토기잠재적림상의의.방법 2009년11월지2011년1월,중산대학부속제삼의원개입혈관과8례복잡문정맥고압환자행경피경간천자간내문체분류술.술전간공능Child-Pugh A급2례,B급3례,C급3례.경피성공천자간내문정맥후,연동일천자도경문정맥천자간단하강정맥(혹간정맥),건립간내문체분류도.결과 8례환자경피경간문체분류술균획득성공.술후문정맥압력유술전(31.0±4.3) mm Hg강지(18.9±2.7) mm Hg(t 10.258,P＜0.01).1례술후5d인간공능쇠갈사망；기여7례존활환자수방2 ～ 20개월,중위수방시간9개월.1례문정맥계통미만혈전환자,4개월후분류도폐새；1례완고성복수환자2개월후복창증상복발,재차치입지가후복수초실；여5례수방기간미재발출혈,반수적복수증상소실.결론 경피경간천자간내문체분류술위복잡문맥고압증환자적간내문체분류제공료일충안전、유효적치료방법,수술성공솔고,시상규경경정맥간내문체분류술적유효보충.
Objective To introduce an innovative procedure for portal hypertension with preliminary results and assess the technical feasibility and efficacy of portosystemic shunt creation through percutaneous transhepatic approach with its potential clinical significance.Methods Between November 2009 and January 2011,8 patients with complicated portal hypertension underwent percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS).The severity of liver disease was Child's A (n =2),Child's B (n =3) and Child's C (n =3).Under fluoroscopic guidance,portal vein (PV) was punctured with a 22-gauge Chiba needle.A 0.018-inch guidewire was advanced through the needle into PV lumen.The needle was exchanged and a 7-French sheath inserted over the wire.Then retrohepatic inferior vena cava (RIVC) or hepatic vein (HV) was punctured with a 20-gauge,20-cm Chiba needle through sheath.Another 0.018-inch guidewire was advanced through the needle into right internal jugular vein and then snared out of body.A 0.035-inch,260-cm-long stiff shaft wire was then introduced through the transjugular sheath and manipulated into main portal vein (MPV) and then into superior mesenteric vein (SMV).Afterward the PTIPS procedure was completed in the standard transjugular fashion.Results The procedure was technically successful in all patients.And effective portal decompression and free antegrade shunt flow were achieved.The mean portal pressure gradient decreased from 31.0 ± 4.3 to 18.9 ± 2.7 mm Hg before and after PTIPS creation respectively and the difference was significant statistically (P ＜ 0.01).Among 8patients,1 developed hepatic coma and died after 5 days while the other 7 patients survived.The median follow-up period was 9 months (range:2-20).Among 5 patients with PTIPS created for bleeding varices,no recurrent bleeding occurred during the follow-up period.For the patient with diffuse portal vein thrombosis,the clinical symptoms disappeared after PTIPS and computed tomography (CT) showed the shunt was occluded after 4 months.One patient with refractory ascites had a recurrence of abdominal distention after 2 months.There was a stenotic shunt on CT.Cure was achieved by replanting a stent in MPV.Conclusion PTIPS is both safe and effective for the treatment of portal hypertension with exceptionally challenging anatomy.It is an available supplement for transjugular intrahepatic portosystemic shunt.