摘要
目的 探讨经皮脾穿刺门静脉插管（PTSPC）技术的可行性.方法 30例门静脉高压症患者接受经PTSPC行食管胃底曲张静脉栓塞术,其中2例同时接受门静脉支架植入术.病例纳入标准：门静脉主干阻塞（癌栓或血栓）和肝硬化严重肝萎缩患者;排除标准：凝血酶原时间（PT）＞20 s的严重凝血功能不良患者.17例患者为原发性肝癌合并门静脉主干癌栓、13例为肝硬化合并严重肝萎缩和（或）小至中量腹水.30例患者术前均有食管胃底静脉曲张破裂出血病史;术前凝血功能正常（PT＜14 s）16例,轻度降低（PT 14～17 s）10例,中度降低（PT 18～20 s）4例;均接受上腹部CT增强检查,并依据CT结果确定脾静脉分支的穿刺位置、方向及深度.术后回顾性分析PTSPC要点、并发症及临床应用价值.结果 30例患者,28例成功应用PTSPC进行门静脉插管;2例插管未成功者均为脾静脉脾内分支细小.发生与PTSPC相关并发症6例（20.0%）,均为不同程度血红蛋白浓度下降（15～50 g/L）;其中4例需要输血治疗,包括1例腹腔大出血,在术后2 h出现血压严重下降,经输入4个单位红细胞和补充血容量后好转.PTSPC成功的28例均行食管胃底曲张静脉栓塞术,其中2例在栓塞曲张静脉的基础上放置门静脉覆膜支架.28例患者术后中位随访时间6个月（1～42个月）,死亡16例,其中14例为肝癌患者在术后1～12个月死亡,2例肝硬化患者分别在术后14、23个月死于肝功能衰竭.随访期间,发生静脉曲张再出血4例,累积再出血率为14.3%.结论 PTSPC是可行的,为经导管门静脉腔内治疗提供了一条新路径,但穿刺部位出血应引起足够重视.
Objective To evaluate the feasibility of percutaneous transsplenic portal vein catheterization （PTSPC）. Methods Thirty patients with portal hypertension underwent gastroesophageal variceal embolization via PTSPC route, 2 of which simultaneously underwent portal vein stenting. This study included the patients with portal venous obstruction （ tumor embolus or thrombus） or the patients with serious liver atrophy caused by liver cirrhosis. The patients who had severe coagulation insufficiency （with prothrombin time 〉 20 s） were excluded. Of the 30 patients, 17 had primary hepatocellular carcinoma with main portal venous tumor embolus, 13 had cirrhosis with severe liver atrophy and（or） slight or moderate ascite. Before this study, all of 30 patients had a history of variceal bleeding, and 16 patients had a normal coagulation level, 10 patients had a mildly prolonged prothrombin time （14-17 s）, 4 patients had a moderately prolonged prothrombin time （18-20 s）. All of 30 patients underwent upper abdomen CT enhanced scanning before this procedure, and the site, direction, and depth of splenic vein branch puncture were decided by CT images. The technology of PTSPC, procedure-related complications, and its clinical application were retrospectively analyzed. Results PTSPC was performed successfully in 28 of 30 patients. Two cases failed because of a small intrasplenic vein. Procedure-related complications occurred in 6 patients （20. 0% ）, which had decrease of hemoglobin concentration （ 15-50 g/L）. Four of them needed blood transfusion. In the six patients, one patient （3.3%） with abdominal cavity hemorrhage had a serious drop of blood pressure 2 hours after procedure, whose clinical symptoms were relieved after four units of packed RBC and a great quantity of fluid were transfused. Twenty-eight patients whose PTSPC were successfullyperformed underwent variceal embolization, 2 of them were placed with portal vein covered stents. During a median follow-up period of 6 months （range： on
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2010年第5期513-517,共5页
Chinese Journal of Radiology
基金
广东省部产学研合作项目（2008A030201004）
关键词
高血压
门静脉
穿刺术
脾脏
栓塞
治疗性
放射学
介入性
Hypertension, portal
Punctures
Embolization, therapeutic
Spleen
Radiology, interventional
