经皮穿脾门静脉置管的实验研究  

Percutaneous Transsplenic Portal Indwelling Catheterization: An Experimental Study

作　　者：程洁敏[1] 王建华[1] 龚高全[1] 陈颐[1] 史留生[2] 

机构地区：[1]上海医科大学附属中山医院放射科,200032 [2]上海医科大学附属中山医院病理科,200032

出　　处：《临床放射学杂志》2002年第2期146-149,共4页Journal of Clinical Radiology

基　　金：国家"九五"攻关项目 (批准号 :96-90 7-0 3 -0 1)

摘　　要：目的　研究经皮穿脾门静脉置管的可行性。材料与方法　家猪 5头 ,穿刺针 ,导丝 ,导管 ,引流管等。先作腹部CT平扫 ,根据CT片作穿刺定位 ,用逆向法和进腹法作经脾门静脉置管。术中观察穿刺点出血情况 ;术后 3、7、14、30天分别处死实验动物 ,观察脾脏穿刺点情况 ,导管情况 ,以及感染情况。脾脏穿刺点作病理检查。结果　5头实验动物全部存活 ,处死动物时脾脏穿刺点表面情况肉眼观察 :3头实验动物脾脏留置管全部脱出 ,2头实验动物的导管不通 (分别为 14天组和 30天组 )。血肿情况 :3天组实验动物脾脏穿刺点表面有陈旧暗红色血肿块 ,7天组血块不明显 ,代之为少量纤维粘连。 14天组有一个动物脾脏穿刺点表面光洁 ,仅见一小的穿刺疤痕。另一动物有大量纤维组织粘连。 30天组的脾脏表面也为粘连的纤维组织。病理切片所见 :主要为穿刺处脾组织镜下出血 ,除看到脾脏细胞外 ,主要为红细胞融合成片。随时间的推移 ,红细胞数减少 ,14天后基本趋于正常。结论　经脾穿刺门静脉置管最大的风险为脾脏穿刺置管时的损伤造成的出血。出血的最高机率为术后 1周内 ,为防止危及生命 ,应该在术前作好出凝血方面的实验室检查 ,如有出凝血功能障碍 ,应予纠正。如果不能纠正就应列为脾穿刺的禁忌症。穿刺时使用细针和细导管。而且?Objective To evaluate the feasibility of percutaneous transsplenic portal indwelling catheterization.Materials and Methods Five pigs were used for the study. Under CT guidance, splenoportography was made after successful puncture of the splenic portal vein. The hogs were sacrificed at 3, 7, 14 and 30 days. The punctured point, dwelling catheter and the presence of infection were observed. Pathological examination of splenic punctured site was made. Results Three catheters were deviated from the portal vein and the two other catheters were occluded. Old dull red hematoma was seen at splenic punctured site at 3 days, which became fibrous tissue at 7 days. Pathologically, microscopic bleeding of the spleen was found at punctured site with lots of RBC around, which was reduced with the time.Conclusion Percutaneous transsplenic portal indwelling catheterization is a feasible and safe technique when ample preoperative preparation is made and the operator is experienced. Its main risk is splenic bleeding. Any dysfunction of blood coagulation should be corrected before the procedure, and fine needle and catheter should be used during the procedure.

关 键 词：门静脉高压 经脾静脉门静脉造影 直接门静脉造影术 实验研究 CT定位 

分 类 号：R815[医药卫生—放射医学]