摘要
目的探讨在肝后段下腔静脉(RHSIVC)与肝内门静脉之间建立直接性肝内门腔分流(DIPS)的临床应用价值。方法采用B超结合X线透视引导穿刺,为13例门脉高压患者(3例同时合并有肝癌)实施DIPS术,对1例合并有肝癌的患者同时行经肝动脉化疗栓塞术(TACE)。所有患者术前均行上腹部增强CT检查,测量RHSIVC的直径、长度及周围肝实质包绕RHSIVC的范围,分别对患者术前、术后红细胞计数、血红蛋白量、肝功能、血氨水平及门腔压力差的改变进行比较,采用彩超对分流道的通畅情况进行随访。结果13例DIPS术均获成功,患者门腔压力差由术前的(27.94±5.29)mmHg(16～35mmHg)降至分流后的(9.22±1.83)mmHg(12～30mmHg)(P<0.001)。术后3天,1例肝癌患者(同时行TACE术)死于急性肝功能衰竭;另1例患者出现血性腹腔积液;其余11例患者无严重的并发症发生。12例存活患者分流道平均通畅时间为176天,术后30、90、180天分流道的累计通畅率分别为100%、80%、80%。结论在RHSIVC及门静脉之间建立DIPS安全、可行,可作为传统TIPS术的改良与补充,在临床上进一步推广。
Objective To evaluate the clinical value of creating direct intrahepatic portacaval shunt （DIPS） between retrohepatic segment of inferior vena cava （RHSIVC） and portal vein. Methods DIPS was created in 13 patients with portal hypertension under sonography combined X-ray guidance. One of the 3 patients with hepatic carcinoma was treated by transcatheter arterial chemoembolization （TACE） simultaneously. Every patient undertook up abdominal enhanced CT examination before procedure to measure the length and diameter of RHSIVC and the extension of RHSIVC encircled by the surrounding hepatic parenchyma. Patient＇s erythrocyte and haemoglobin counts, hepatic function, serum NH3 level and portacaval pressure gradient was compared before and after DIPS respectively. Patency of shunt was followed by Doppler ultrasound. Results Thirteen DIPS were successfully created in all patients. After DIPS, the patient＇s portacaval pressure gradient was declined from （27.94±5.29） mmHg （16～35 mmHg） to （9.22±1.83） mmHg（12～30 mmHg） （P〈0. 001）. Except one patient with HCC who was treated by TACE simultaneously had complication of acute hepatic failure and died 3 days after procedure, another patient complicated hemoascites, the remaining 11 patients had no serious procedure-related complications. Kaplan-Meier analysis yielded a primary patency of 176 days for 12 survival patients. Thirty, 90, and 180 days＇ cumulative patency rates were 100%, 80% and 80% respectively for the DIPS shunt. Conclusion Our initial experience demonstrated DIPS seemed to be a feasible and safe procedure to treat portal hypertension. Further study will be necessary to generalize DIPS procedure clinically.
出处
《中国介入影像与治疗学》
CSCD
2006年第3期190-194,共5页
Chinese Journal of Interventional Imaging and Therapy
关键词
门腔分流术
门静脉压
下腔静脉
Portacaval shunt
Portal pressure
Inferior vena cava
