经皮经肝门腔静脉分流术  

Percutaneous transhepatic portacaval shunt (PTPS)

作　　者：褚建国[1] 孙晓丽[1] 吕春燕[1] 徐晓明[1] 黄鹤[1] 杨淑惠[1] 周华[1] 

机构地区：[1]北京空军总医院放射科,100036

出　　处：《介入放射学杂志》2005年第4期367-371,共5页Journal of Interventional Radiology

摘　　要：目的介绍一种经皮治疗门静脉高压症的新方法,评价其安全性和可行性,探讨其潜在的临床意义。方法19例门静脉高压患者行经皮经肝门腔静脉分流术(PTPS)。其中食管胃底静脉曲张出血16例,难治性腹水2例,肝肺综合征1例;Child’sB级4例、C级15例。经皮经肝穿刺门静脉左支再穿刺肝段下腔静脉,经皮经肝方向植入PTFE覆膜支架于门静脉左支与腔静脉之间。结果19例经肝段下腔静脉PTPS分流术均获成功,技术成功率100%,未出现术中技术相关并发症,术后门腔静脉压力梯度平均下降13cmH2O,平均随访216d,所有患者未发生再出血,难治性腹水得到有效控制。1年内初步开通率94.8%,明显高于传统TIPS。结论经皮经肝途径建立门腔静脉分流是安全可行的,1年内支架初步开通率明显高于传统TIPS。Objective To present a latest procedures for portal hypertension with preliminary results and evaluate the technical feasibility and efficacy of the portacaval shunt creation through percutaneous transhepatic approach with its potential clinical significance. Methods Nineteen patients with portal hypertension （17 men; mean age 57 years, range 32- 73） were referred for PTPS procedure because of bleeding varices （n = 16）, intractable ascites （n = 2）, and hepatopulmonary syndrome （ n = 1 ）. The severity of liver disease was Child＇ s B in 4 and Child＇s C in 15. The PTPS was created by a percutaneous transhepatic puncture through left portal vein to the IVC and a polytetrafluoroethylene （PTFE） stent- grafts was placed through a transhepatic approach. Results Technical and functional successes were achieved in all patients-arerage without any procedure-related complications. The postprocedural portal vein- IVC gradients decreased with a mean 13 emil20 and with average 216 days of follow-up showing no recurrent variceal bleeding and refractory ascites. The primary potency ratefor 365 days was 94.8% ,obviously higher than classical TIPS. Conclusions Portacaval shunt creation using the percutaneous transhepatic technique is secure and feasible with favorable primary patency due to the a straight line shunt construction and provide a good alternative to the standard portosystemic shunt in difficult or impossible circumstances. （J lntervent Radiol,2005,14：367-371. ）

关 键 词：门静脉 高血压 门腔静脉分流 肝脏介入 经皮经肝 门腔静脉分流术 经皮经肝穿刺 食管胃底静脉曲张出血 门静脉高压症 难治性腹水 

分 类 号：R575.2[医药卫生—消化系统]