经脾肾静脉带膜支架分流术对门静脉高压猪模型的降压效果及可行性

Percutaneous retroperitoneal splenorenal stent shunt： an experimental study in swine model with portal hypertension

目的 通过介入方法对具有急性门静脉高压的猪模型进行经脾肾静脉带膜支架分流术,探讨其分流降压效果及可行性.方法 健康西藏小型猪共5只,通过向门静脉内注射PVA颗粒制作急性门静脉高压模型;之后行脾肾静脉分流术,在脾静脉与左肾静脉之间释放带膜支架,观察相关静脉压力变化,术后行脾静脉血管造影显示静脉及支架内血流情况.结果 5只猪均成功建立急性门静脉高压模型,随后进行经脾肾静脉分流术,其中1只于术中死亡（死于麻醉过量）,其余4只释放支架成功,术后脾静脉血管造影示支架内见由脾静脉向左肾静脉血流,分流术后门静脉、脾静脉压力均较注射PVA后下降,左肾静脉压力有所上升.结论 猪的门静脉高压模型经腹膜后脾肾静脉分流术在技术上是可行的,其疗效及安全性尚需进一步实验研究.

Objective To evaluate the effect of depressing the press and the technical possibility of creating a percutaneous retroperitoneal splenorenal shunts （PRESS） by means of treating with swine with portal hypertension. Methods There were five normal microswine, all of which underwent portal vein embolization with polyvinyl alcohol （PVA） particles to creat the model of portal hypertension. After the successful creation of the model with portal hypertension, PRESS were placed to depress the portal venous press, placing covered-stents to connect the left renal vein and the splenic vein. The variance of relative venous press was observed. Splenic venogram was taked after the PRESS to observe the condition of blood flow in the vein and stents. Results Acute portal hypertension were created successfully in the five animals,then PRESS were placed . One animal died during the opertaion（died of overdose of anesthesia）,stent placement were successfully completed in the other four animals. The splenic venogram revealed good flow from the splenic vein to the left renal vein through the shunt track. After the PRESS, the portal venous and the splenic press press descended, and the left renal press elevated. Conclusion Creation of a PRESS for swine with portal hypertension is technically possible, and further experimental studies of its safety are warranted.