支架嫁接分流术治疗肝小静脉闭塞病

Stent graft shunt for treatment of hepatic veno-occlusive disease

目的评价肝小静脉闭塞病(Hepatic veno-occlusive disease,HVOD)介入治疗的可行性及探讨两步法嫁接支架"吻合"建立门腔分流新技术的临床意义。方法 21例临床上均符合巴尔的摩(Baltimore)标准和西雅图(Seattle)标准[1]的HVOD患者首先行下腔静脉支架术,恢复其肝后下腔静脉血流,再经其支架缝隙穿刺肝内门静脉分支,将两支架进行嫁接。静脉曲张出血4例,难治性腹水16例,肝肺综合征1例;Child's B级6例、C级15例。结果 21例肝小静脉闭塞病患者两支架嫁接分流术均获成功,技术成功率100%,未出现术中技术相关并发症,术后门腔压力梯度平均下降23cmH2O,平均随访416d,所有患者未发生再出血,难治性腹水得到有效地控制。一年内初步开通率100%。结论肝小静脉闭塞病两步法嫁接支架"吻合"分流术是安全可行的,结果提示:由于肝小静脉闭塞病肝肿大,尾叶压迫肝后下腔静脉的特殊性,两步法嫁接支架"吻合"建立门腔分流新技术比单一介入方法干预具有明显的临床效果优势。

Objective To evaluate the possibility of interventional therapy of Hepatic veno-occlusive disease and to explore the clinical signifi cance of new technologies in establishment of portacaval shunt. Methods Twenty-one cases of hepatic veno-occlusive disease received inferior vena cava stenting fi rstly to restore the blood flow of subhepatic inferior vena cava. Then intrahepatic portal vein was punctured via the bracket slot,and the two stents were connected. In all patients,there were variceal bleeding in 4 cases,refractory ascites in 16 cases,1 case of hepatopulmonary syndrome;Child＇s B grade was in 6 cases,C in 15. Results Of 21 cases,two stents were successfully shunt,technical success rate was 100%. Operation-related complication did not appear,postoperative portosystemic pressure gradient decreased 23cmH2O. After average follow-up 416d,no patient had rebleeding and refractory ascites had been effectively controlled. Year Primary patency rate at 1 year was 100%. Conclusion It is safe and feasible of two-step method ＂anastomose＂ technique to treat Hepatic veno-occlusive disease. The results suggest： As hepatic veno-occlusive disease complicates with hepatomegaly,that compress the subhepatic inferior vena cava,the new technology in establishment of portal shunt has obvious advantages of clinical effect to single interventions.