门静脉穿刺造影改良经颈静脉肝内门体分流术治疗门静脉高压上消化道出血  

Use of direct portal vein puncture portography with modified TIPS treatment in patients with portal hyper- tension and gastro-esophageal varices bleeding

作　　者：李常青[1] 许东海[1] 徐道振[1] 李洪璐[1] 褚建国[2] 李新民[1] 马轶[1] 井庆红[3] 

机构地区：[1]北京地坛医院介入放射科,100011 [2]中国人民解放军空军总医院放射科 [3]北京地坛医院超声科,100011

出　　处：《中华肝脏病杂志》2005年第6期403-406,共4页Chinese Journal of Hepatology

摘　　要：目的探讨经颈静脉肝内门体分流术(TIPS)的改良方法,提高其穿刺准确性和安全性,拓宽TIPS治疗适应证。方法在B超引导下经皮经肝穿刺门静脉右支,成功后引入带金标导管进行门静脉造影、测压、栓塞胃冠状静脉,然后将金标置于门静脉靶穿刺点,引导Rups-100穿刺门静脉,进行门静脉正、侧位造影,确保门静脉穿刺点在距离分叉2 cm以上。有门静脉血栓者用10F鞘管吸出,陈旧血栓用支架旷置。球囊扩张肝实质分流道,置入支架,造影测压。结果20例肝硬化门静脉高压上消化道出血患者用改良TIPS方法治疗均获得成功,上消化道出血即刻得到控制;20例患者共穿刺37针,平均(1.85±0.67) 针;门静脉压力由(30.5±1.1)mm Hg降至(16.9±0.9)mm Hg,治疗前后门静脉压力差异有统计学意义(P<0.05)。4例间接门静脉造影未见显影放弃TIPS治疗的患者,经改良TIPS治疗后也获得成功。20例患者共放置25枚支架,未出现一例与TIPS操作有关的并发症。结论直接门静脉穿刺造影金标定位引导TIPS 操作,可提高TIPS穿刺准确性和安全性,进一步拓宽了TIPS治疗适应证,有利于TIPS技术进一步推广。Objective To explore a better procedure for transjugular intrahepatic portosystemic shunt (TIPS) in order to improve its safety and to extend its indications. Methods To puncture the right portal branch under sonographic guidance in 20 patients with portal hypertension and gastro-esophageal bleeding. The Teflon sheath with gold marker was put into the portal vein; anterior and lateral portography was made, portal pressure was measured and the gastric coronal vein was embolized. The gold marker was put into the portal vein puncture site and the Rups-100 was guided under the gold marker during the TIPS puncture procedure. Anterior and lateral portography was again made to make sure the puncture site was 2 cm away from the portal vein bifurcation. In some cases a 10F sheath was used to suck the thrombosis in the portal vein, and a balloon was used to dilate the parenchyma channel and then a stent was released smoothly. Results 20 reformed TIPS were successfully performed on all patients and their gastric-esophageal bleedings were controlled immediately. 37 punctures were made in 20 of those cases; the average puncture per patient was 1.85 ± 0.67, lower than that of the traditional method. The pressure of the portal vein declined from (30.5 ± 1.1) mm Hg to (16.9 ± 0.9) mm Hg, P < 0.05, showing that the difference of portal vein pressure before and after the reformed TIPS was significant. 25 stents were placed, and no complications occurred during the procedure in any of the cases. Conclusion Direct portal vein puncture portography and gold marker guided TIPS procedure is feasible and safe; the indications of TIPS could be further extended.

关 键 词：经颈静脉肝内门体分流术 上消化道出血 穿刺造影 肝硬化门静脉高压 TIPS 间接门静脉造影 治疗适应证 经皮经肝穿刺 门静脉右支 胃冠状静脉 静脉穿刺点 门静脉血栓 门静脉压力 改良方法 B超引导 球囊扩张 置入支架 出血患者 

分 类 号：R657.3[医药卫生—外科学] R573.2[医药卫生—临床医学]