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[2] 徐晓明[1] 陈学忠[1] 黄鹤[1] 朴龙松[1] 吕春燕[1] 杨淑惠[1] 

机构地区：[1]空军总医院放射科,北京100036 [2]空军总医院核医学科,北京100036

出　　处：《空军总医院学报》2004年第2期63-66,69,F002,共6页Journal of General Hospital of Air Force,PLA

摘　　要：目的　评价经皮经肝途径建立门腔静脉分流术的可行性及探讨其临床意义。　方法　 19例门静脉高压患者行经皮经肝途径门腔静脉分流术 (PTPS)。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 ,经肝植入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TIPS分流术均获成功 ,技术成功率 10 0 % ,未出现术中与操作技术相关并发症 ,术后门腔压力梯度平均下降 13cmH2 O ,平均随访 2 16d ,所有患者未发生再出血 ,难治性腹水得到有效地控制。一年内初步开通率 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 ,结果提示由于PTPS肝内具有顺直的分流道的优势 ,一年内支架初步开通率明显高于传统TIPS。Objective To evaluate the technical feasibility and efficacy of portacaval shunt creation by the percutaneous transhepatic approach. Methods Nineteen patients with portal hypertension (17 men;mean age 57 years,range 32～73 years) were referred for PTPS procedures 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 and the IVC;a polytetrafluoroethylene (PTFE) 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 cmH 2O. The mean of follow-up period is 216 days. None of the patients treated for variceal bleeding episode,refractory ascites benefit from the procedure. The primary patency rates at 365 days were 94.8%. primary patency rate is obvious higher than classical transjugular intrahepatic portosystemic shunt(TIPS). Conclusion Portacaval shunt creation using the percutaneous transhepatic technique is secure and feasible. The results suggest the PTPS offers favorable primary patency because shunt has a straight line shunt construction and it is a good alternative when standard portosystemic shunt creation is difficult or impossible.

关 键 词：高血压 门静脉 门腔分流术 外科 肝 外科学 

分 类 号：R654.3[医药卫生—外科学]