经皮经肝门腔静脉分流术血流动力学与支架构型关系的临床研究  

The clinical study of structure of prefabrication stress stent and hemodynamics in Percutaneous transhepatic portacaval shunt (PTPS)

作　　者：褚建国[1] 孙晓丽[2] 黄鹤[1] 徐晓明[1] 周华[1] 吕春燕[1] 杨淑惠[1] 邹一军[1] 

机构地区：[1]空军总医院放射科,北京100036 [2]空军总医院临床检验中心,北京100036

出　　处：《空军总医院学报》2006年第3期134-137,F0002,共5页Journal of General Hospital of Air Force,PLA

摘　　要：目的介绍一种全新肝内分流预应力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区别,探讨其潜在的临床意义。方法38例门静脉高压患者采用预应力支架行经皮经肝途径门腔静脉分流术(PTPS)。静脉曲张出血36例,难治性腹水1例及肝肺综合征1例;Child’s 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%,未出现术中与技术相关并发症,术后门腔压力梯度平均下降14 cmH2O,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98.9%,明显高于经典直管形裸支架TIPS。结论采用预应力支架经皮经肝途径建立门腔静脉分流是安全可行的,其血流动力学结果提示:预应力支架形状及与相关血管壁间“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,亦保障了门静脉右支血流的肝内灌注,对预防术后分流道再狭窄及降低肝性脑病发生率具有明显的临床意义。Objective To present a latest procedures for portal hypertension preliminary results and evaluate the technical feasibility and efficacy of portacaval shunt creation through the percutaneous transhepatic approach. Methods Thirty-eight patients with portal hypertension （36 men; mean age 57 years, range 32-73） were referred for PTPS procedures because of bleeding varices （n=36）, intractable ascites （n=1）, and hepatopulmonary syndrome （n=1）. The severity of liver disease was Child＇s B in 27 and Child＇s C in 11. The PTPS was created by a percutaneous transhepatic puncture through left portal vein to the IVC; a prefabrication stress stent-grafts was placed through a transhepatic approach. Results Technical and functional success was achieved in all patients. The success rate is 100%. Did not take place the related complications in the technique. The postprocedural portal vein-IVC gradients mean 13 cmH2O. The follow up period mean 493 days. None of the patients had variceal bleeding episode, refractory ascites were controlled after the procedure. The primary patency rates at 365 days were 94.8%. primary patency rate is obvious higher than classical TIPS. Conclusion Portacaval shunt creation using the prefabrication stress stent with percutaneous transhepatic technique is secure and feasible. The results of hemodynamics suggest the figure of prefabrication stress stent suits anatomical configuration, postprocedural hemodynamics accord with originality.

关 键 词：肝 高血压 门静脉/外科学 口腔分流术 外科/方法 放射学 介入性 

分 类 号：R654.3[医药卫生—外科学] R657.34[医药卫生—临床医学]