覆膜支架成形术治疗癌栓性门静脉狭窄的临床应用  

Clinical application of endovascniar stent-graft in the treatment of portal stenosis of cancerous thrombus

作　　者：姜在波[1] 黄明声[1] 王劲[1] 李征然[1] 钱结胜[1] 关守海[1] 朱康顺[1] 张雄军[2] 单鸿[1] 

机构地区：[1]中山大学附属第三医院放射科,广州510630 [2]云南省玉溪市人民医院介入科

出　　处：《中华放射学杂志》2007年第3期296-299,共4页Chinese Journal of Radiology

摘　　要：目的初步探讨覆膜支架成形术治疗癌栓性门静脉狭窄的技术要点及早期疗效。方法 5例原发性肝癌和1例胆总管癌患者,增强 CT 显示门静脉癌栓形成致门静脉主干狭窄超过75%(2例闭塞)。采用经皮、经肝与经皮、经脾途径介入治疗,在狭窄部位放置直径10 mmFLUENCYT^(TM)覆膜支架,术后以氰基丙烯酸正丁酯(NBCA)胶栓塞曲张胃冠状静脉及穿刺通道。支架置入前、后测量门静脉压力。结果 6例患者手术全部成功,支架成形前门静脉压力平均50.7 cmH_2O(1 cm H_2O=0.098 kPa),术后平均41.3 cm H_2O,平均降低9.4 cm H_2O。1个月后复查,2例支架内栓子形成,再狭窄,出现呕血、大量腹水症状,其余4例患者未发生门静脉高压导致的严重症状。结论覆膜支架成形术治疗癌栓性门静脉狭窄安全可行,选择合适的适应证能有效控制门静脉高压的症状。Objective To explore the approach and early effects of endovascular stent-graft deployment in the treatment of portal stenosis of cancerous thrombus. Methods Six cases with portal vein stenosis of cancerous thrombus, which caused by primary hepatic carcinoma （5 cases ） and cholangiocarcinoma （1 case） and the severity of stenosis showed on contrast enhanced CT were more than 75% or occluded, were performed percutaneous transhepatic or transspleuic portography. FLUENCYTM endovascular stent-graft （10 mm diameter） was placed at the position of stenosis after gastroesophageal varices embolization. Portal pressure was measured pre- and post-deployment. Results Stents were successfully placed in all patients. The average portal pressure decreased from 50. 7 cm H2O （ 1 cm H2O = 0. 098 kPa） to 41.3 cm H2O after endovascular stent-graft deployment. The restenosis were found in 2 cases after one month. Haematemesis and refractory ascites appeared in one case respectively, the other 4 cases showed no significant symptoms above caused by portal hypertension. Conclusion It is safe and feasible for endovascular stent-graft deployment in the treatment of portal stenosis of cancerous thrombus. Selecting the suitable indications, the symptoms of portal hypertension can be controlled effectively.

关 键 词：高血压 门静脉 肿瘤循环细胞 支架 血管成形术 

分 类 号：R735[医药卫生—肿瘤]