摘要
目的观察穿刺肝内支架辅助经颈静脉途径开通TIPS术后分流道闭塞的应用价值。方法对经单纯颈静脉途径行分流道再通术失败的12例TIPS术后分流道闭塞患者行肝内分流道支架穿刺,辅助经颈静脉通路进行再通,观察术中及术后情况。结果对12例(12/12,100%)均成功经皮经肝穿刺肝内分流道支架。于10例(10/12,83.33%)实现分流道再通,术前门静脉压力为(29.20±2.04)cmH_(2)O,术后为(21.70±1.70)cmH_(2)O;对2例(2/12,16.67%)术前无症状患者未能通过分流道,予口服β受体阻滞剂降低门静脉压力治疗。术中对7例(7/12,58.33%)经肝脏穿刺道置入血管鞘,另5例(5/12,41.67%)仅以导丝穿过闭塞的分流道而未置入血管鞘。术中未发生穿刺道出血等穿刺相关并发症。术后1年,10例成功再通患者TIPS分流道通畅率为90%(9/10)。随访5~60个月期间无肝性脑病、肝性脊髓病或门静脉高压症状复发,无死亡。结论对于经颈静脉通路再通失败的TIPS术后分流道闭塞患者,经肝穿刺分流道内支架可安全、有效地辅助经颈静脉途径实现再通。
Objective To observe the application value of transhepatic puncture of stent for assisting transjugular approach recanalization of occluded shunt after TIPS.Methods Twelve patients with shunt restenosis or occlusion after TIPS that failed to be recanalized via jugular vein access alone underwent transhepatic stent puncture for assisting transjugular approach recanalization.The intraoperative and postoperative conditions of these patients were observed.Results Transhepatic puncture of stent was successfully performed in all 12 patients(12/12,100%).Recanalization of the shunt was achieved in 10 cases(10/12,83.33%)with preoperative portal pressure of(29.20±2.04)cmH_(2)O and postoperative of(21.70±1.70)cmH_(2)O,but failed in 2 asymptomatic cases(2/12,16.67%)failed to pass the occluded shunt who were then treated with oralβ-blockers.Vascular sheath was inserted through liver puncture in 7 cases(7/12,58.33%),while in the other 5 cases(5/12,41.67%)only the guide wire passed through the occluded shunt.No bleeding nor other puncture related complications occurred.One year after recanalization,the shunt patency rate was 90%(9/10).During 5—60 months'following-up,there was no recurrence of hepatic encephalopathy,hepatic myelopathy,portal hypertension nor death.Conclusion For patients with shunt restenosis or occlusion after TIPS that failed to be recanalized via jugular vein access alone,transhepatic shunt stent puncture was safe and effective for assisting transjugular approach recanalization.
作者
孙占国
韦晓雯
焦德超
方毅
周朋利
韩新巍
SUN Zhanguo;WEI Xiaowen;JIAO Dechao;FANG Yi;ZHOU Pengli;HAN Xinwei(Department of International Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450050,China;Department of Geriatric Endocrinology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450050,China)
出处
《中国介入影像与治疗学》
北大核心
2022年第7期396-400,共5页
Chinese Journal of Interventional Imaging and Therapy
关键词
高血压
门静脉
支架
门体分流术
经颈静脉肝内
hypertension,portal
stents
portasystemic shunt,transjugular intrahepatic
