旋转DSA在经皮穿肝胃底曲张静脉栓塞术中的应用

Application of rotational DSA in percutaneous transhepatic variceal embolization

目的:探讨旋转DSA在经皮穿肝胃底曲张静脉栓塞术中的应用价值。材料和方法:采用东芝2000A型血管造影系统,62例肝炎肝硬化病人均伴有不同程度的门静脉高压及消化道出血史。经超声引导下经皮穿肝至门静脉造影,根据胃底曲张静脉的范围逐一对胃冠状静脉和胃底静脉进行常规正位DSA和旋转DSA检查,比较两种方法在曲张静脉的显示和超选择介入治疗方面的作用。结果:62例中21例常规正位DSA的二维影像不能充分显示重叠血管形态及分支,而旋转DSA的三维影像均能清晰显示并可锁定导管最佳插入角度指导栓塞治疗。结论:与常规正位DSA比较,旋转DSA的三维影像能够多方位清晰显示迂曲走行的曲张静脉血管团的空间结构,对提高超选择性插管的成功率及指导胃底曲张静脉栓塞治疗有重要的临床价值。

Objective： To investigate the value of rotational DSA in percutaneous transhepatic variceal embolization（FFVE）. Materials and Methods： With Toshiba 2000A DSA unit, all 62 patiens have anisodegree portal hypertension and hemorrhage history of digestive tract, which are due to cirrhosis of liver after hepatitis. Percutaneous transhepatic portal vein angiography was practiced under ultrasound, based on the extent of gastroesophageal varicose vein, coronary vein of stomach and gastric fundus vein was examined one by one using conventional DSA and rotational DSA. The detection of the varicose vein and the effect of the ultra-selective interventional treatment were compared between conventional and rotational images. Result： A total of 62 cases, two-dimensional images of the routine proper DSA couldn＇t completely display the appearance and sub-branches of the overlapped vein in 21 cases. But three-dimensional images of the rotational DSA could completely display and supervised the interventional therapy through the optimal angle of catheterization being locked. Conclusion： Compared with conventional DSA, three-dimensional images of the rotational DSA can well display spacial structure of the tortuous vein from different angles, rotational DSA is of great help for improving the successful rate of super-selective catheterization, and thus is a valuable examination for FIVE.