改良COPE穿刺导引系统在经皮穿肝门静脉中的应用

The Application of Modified COPE Puncture System in Percutaneous Transhepatic Portal Puncture

目的：经皮穿肝门静脉是介入放射学中的常见操作方法之一，现仍存在一定的并发症，且大多与操作损伤有关。采取改良ＣＯＰＥ穿刺导引系统可望进一步减少并发症。材料与方法：１４例患者用改良ＣＯＰＥ穿刺导引系统经皮穿肝门静脉，其中３例肝脏体积很小，且伴大量腹水。改良ＣＯＰＥ穿刺导引系统包括：①２２Ｇ千叶针，内可通过０．０１８″导丝；②０．０１８″导丝；③改良ＣＯＰＥ穿刺套管，内芯为２２Ｇ不锈钢套管，中间为Ｆ４扩引管，两者均可通过０．０１８″导丝，外套管为Ｆ５，内可通过０．０３８″导丝。用２２Ｇ千叶针穿入门静脉大分支后用０．０１８″导丝经千叶针进至门静脉主干，更换改良ＣＯＰＥ穿刺套管于门静脉后留下外套管，再经０．０３８″导丝后即可更换各种形态的Ｆ５导管进行操作。结果：所有１４例患者均成功地完成了经皮穿肝门静脉操作，无１例出现并发症。结论：改良ＣＯＰＥ穿刺导引系统是一种安全性很高又非常实用的穿刺导引系统，适用于经皮穿肝及其他脏器的穿刺引流，尤其适宜于病情较重或一般情况欠佳者，值得在临床上推广。

Objective: Percutaneous transhepatic portal puncture (PTPP) is one of basic interventional performances. The performer's techniuqe is responsible for most of complications of PTPP. Modified COPE puncture system will be helpful in reducing the complications. Materials and Methods:PTPP was performed in 14 patients with modified COPE puncture system. The system consists of three components: ①Chiba needle, 22G; ②0.018″ guidewire; ③Modified COPE puncture cannula, which is assembled by three parts, 22G inner stiffening cannula, F4 middle dilator, both can be passed through by a 0.018″ guidewire ,and F5 outer cannula, through which a 0.038″ guidewire can pass. When a chiba needle was punctured into the larger portal vein branch, a 0.018″ guidewire was inserted to the portal trunk. The Chiba needle was substituted with the modified COPE puncture cannula along the 0.018″ guidewire. After withdrawl the stiffening cannula and dilator, a 0.038″ guidewire was inserted into the outer cannulla, and various F5 catheter may exchanged for selective catheterization. Results:PTPP was performed successfully in all patients without complications.Conclusion: It is safe and applicable to do PTPP and other percutaneous drainage with the modified COPE puncture system, especially in patients in poor condition.