经皮脾穿刺CO_2门静脉造影术的临床应用

Percutaneous transplenic CO_2 digital substraction splenoportography

目的 初步探索经皮脾穿刺CO2 门静脉造影的安全性、造影效果及其临床使用价值。方法 2 0例患者 (男 15例、女 5例 ) ,原发性肝癌 14例 ,转移性肝癌 5例 ,肝硬化 1例 ,以 2 6G超细针在B超引导或透视定位下经皮穿刺至脾内 ,行CO2 DSA。结果 17例清晰显示门静脉 4级以上分支 ,图像质量优 ;2例门静脉主干阻塞 ,门静脉分流显示清晰 ,1例失败。术中 7例患者无任何不适 ,10例患者有轻中度腹部不适 ,2例有恶心感 ,1例腹痛 ,B超示脾包膜下血肿。结论 经皮细针穿刺脾实质CO2 造影可以清晰显示门静脉结构 ,方法简单、快捷、创伤小 ,患者耐受性好 ,安全性高 ,可在临床推广使用。

Objective To evaluate the safety, efficacy and clinical applications of percutaneous transplenic CO_2 splenoportography with fine-needle. Methods Twenty patients (15 males, 5 females, 14 with primary hepatic carcinoma, 5 with hepatic metastatic cancer, and 1 with hepatic cirrhosis waiting for liver transplantation) underwent transplenic CO_2 digital substraction splenoportography with 26 G ultrafine-needle under the guidance of ultrasound or fluorography. Results Excellent images were obtained in 17 cases, depicting up to four-order branches of portal system clearly. Portal vein occlusion, coronary and gastroesophageal varices, and patent shunts were showed in 2 cases. Transplenic CO_2 digital substraction splenoportography procedure failed in 1 case. During all these procedures, 7 cases felt no discomfort, 10 cases had mild to moderate abdominal discomfort, 2 with nausea during injection of CO_2. One patient had abdominal pain, and ultrasound showed splenic subpeplos hemotoma after procedure. Conclusion The percutaneous transplenic CO_2 splenoportography with ultrafine-needle has demonstrated an optimal method of portography, which appears to be less time-consuming, minimally invasive and easy to perform. Safety of this procedure may be increased when practiced by adroit operators.