改良BRTO联合顺行静脉闭塞术治疗门静脉高压合并自发性门体分流  

Treatment of portal hypertension with spontaneous portosystemic shunt using the method of modified balloon-occluded retrograde transvenous obliteration combined with anterograde venous obliteration

作　　者：张强[1] 游国超[1] 徐化静[1] 孔祥翔 杨殿滨 刘岩[1] Zhang Qiang;You Guochao;Xu Huajing;Kong Xiangxiang;Yang Dianbin;Liu Yan(Department of Interventional Radiology and Vascular Surgery,Henan Anyang District Hospital,Anyang,455000,China)

机构地区：[1]河南省安阳地区医院血管科介入中心,安阳455000

出　　处：《中华放射学杂志》2024年第7期752-757,共6页Chinese Journal of Radiology

摘　　要：目的探讨以人体组织黏合剂或联合弹簧圈为栓塞剂的改良球囊阻断逆行性静脉闭塞术(M-BRTO)联合顺行静脉闭塞术(ATO)在门静脉高压合并自发性门体分流(SPSS)治疗中的应用, 并评价其临床疗效。方法回顾性分析2018年2月至2022年10月就诊于河南省安阳地区医院的门静脉高压合并SPSS患者的临床资料, 入组21例患者。首先在SPSS流出道限流下进行ATO, 然后进行M-BRTO。ATO路径可选择经皮经肝、经附脐静脉或经颈静脉肝内门体分流术(TIPS)路径入路, M-BRTO入路可选择股静脉、颈静脉或肘前静脉。孤立胃静脉曲张出血、肝性脑病症状或者心功能不全为主要症状者, 局部麻醉下行M-BRTO+ATO;门静脉高压合并严重的消化道出血、门体分流者, 或合并门静脉血栓者, 全身麻醉下行TIPS+M-BRTO+ATO。术后1周复查腹部平扫CT了解栓塞剂沉积情况, 术后1个月行腹部彩超, 3及6个月行腹部增强CT检查, 以后每半年复查, 了解门静脉血流或TIPS支架通畅情况。合并肝癌者, 术后1个月行肝动脉化疗栓塞治疗。结果 21例患者共行23次栓塞手术, 其中1例先后3次手术。经皮经肝路径治疗11例(其中7例联合股静脉, 3例联合颈静脉, 1例联合肘前静脉), 经TIPS路径+股静脉入路治疗9例, 经附脐静脉+股静脉入路治疗2例, 附脐静脉+肘前脉入路1例。异位栓塞3例(1例至脾静脉, 2例至肝内), 围手术期发热5例, 肝脏穿刺道出血1例, 死亡2例(胆管结石诱发急性肝功能衰竭1例, 急性心衰合并急性消化道大出血1例)。随访期间死亡4例(肝癌3例, 感染1例)。余15例随访2~47(22±13)个月, 随访期间肝性脑病及消化道出血症状无复发。结论以人体组织黏合剂或联合弹簧圈为栓塞剂的M-BRTO+ATO可快速栓塞SPSS流出道, 完全闭塞SPSS, 是治疗门静脉高压合并SPSS快速、安全、有效的方法。Objective To discuss the method of modified balloon-occluded retrograde transvenous obliteration(M-BRTO)combined with antegrade transvenous obliteration(ATO)using tissue adhesive and(or)coils in the treatment of portal hypertension with spontaneous portosystemic shunt(SPSS),and to evaluate its clinical efficacy.Methods From February 2018 to October 2022,clinical data of patients with portal hypertension with SPSS treatment in Henan Anyang District Hospital were retrospectively analyzed.A total of 21 patients were enrolled.Under the blood flow limit of SPSS outflow tract,ATO was firstly performed,then followed by M-BRTO.The ATO route could be performed from percutaneous transhepatic portal vein,percutaneous transumbilical vein or transjugular intrahepatic portal vein shunt(TIPS)approach and the M-BRTO route could be performed from femoral vein(FV),jugular vein(JV)or anterior cubical vein(ACV).The operation of M-BRTO+ATO was performed under local anesthesia and was suitable for patients with isolated gastric varicose bleeding,hepatic encephalopathy or cardiac insufficiency.TIPS combination with M-BRTO+ATO was performed under general anesthesia and was suitable for patients with gastrointestinal hemorrhage complicated with severe gastrorenal or splenorenal shunt,or with portal thrombosis.Abdominal plain CT scan was performed 1 week later to show the deposition of embolic agent.Abdominal color ultrasound was done 1 month later,contrast-enhanced CT scan was performed 3 months and 6 months later,and then color ultrasound or contrast-enhanced CT was performed every 6 months to show the portal vein blood flow or the patency of TIPS stent.Hepatic artery chemoembolization was performed 1 month later for patients with liver cancer.Results A total of 23 times of operation were performed in 21 patients,including 1 case with 3 times of operation.The approach of percutaneous transhepatic route was used in 11 cases(7 cases combined with FV,3 cases combined with JV and 1 case combined with ACV),the approach of TIPS route combinat

关 键 词：高血压 门静脉 自发性门体分流 球囊封堵逆行静脉闭塞术 胃静脉曲张 人体组织黏合剂 

分 类 号：R575.2[医药卫生—消化系统] R816.5[医药卫生—内科学]