肝血管性疾病门静脉高压的介入性诊断与治疗

Interventional diagnosis and therapy of portal hypertension resulting from hepatic vascular abnormalities

目的探讨介入方法对肝血管性疾病门静脉高压的诊断和治疗效果。方法 6例因慢性肝病史临床初诊疑似肝硬化门静脉高压的患者,增强CT及MRI检查发现门静脉显影时间及形态异常。经数字减影血管造影(DSA)确诊4例为肝动脉-门静脉畸形,2例为布-加综合征肝静脉狭窄。造影后分别予以选择性肝动脉栓塞和肝静脉扩张成形治疗。结果所有介入性治疗操作均获得技术性成功,无并发症发生。治疗后血管造影显示肝动脉畸形血管完全消失或大部分已不显影,肝静脉狭窄解除。所有患者介入治疗后近期临床门静脉高压症状明显改善或消失。1例弥漫性肝动脉-门静脉瘘患者2次栓塞后6个月发现门静脉主干血栓形成,行溶栓和经颈静脉肝内门体分流术(TIPS)治疗后症状消失;1例布-加综合征肝静脉狭窄于3年后复发,在外院植入肝静脉支架。结论应用介入方法对肝血管性疾病导致的门静脉高压进行确诊和治疗确切有效,是安全而微创性的诊疗手段。

Objective To explore the effect of interventional diagnostic and therapeutic methods for portal hypertension resulting from hepatic vascular abnormalities.Methods Six patients with a history of chronic hepatic disease were firstly diagnosed as cirrhotic portal hypertension.All patients underwent DSA after the abnormalities of portal vein were detected during CT or MRI scan.4 cases of arterioportal malformation and 2 cases of hepatic vein stenosis（Budd-Chiari syndrome） were finally diagnosed by DSA.Hepatic arterial embolization were performed to the arterioportal malformation and hepatic vein balloon angioplasty to the hepatic vein stenoses.Results Therapeutic intervention was successful in all cases.No complication was observed.Hepatic vascular malformation and hepatic vein stenosis disappeared totally or mainly in the post-treatment angiography.The clinical symptoms of portal hypertension improved significantly in short term.A case of extensive arterioportal malformation underwent second arterial embolization and then a TIPS treatment because of portal vein thrombosis.A case of restenosis of hepatic vein occurred 3 years later and the patient received a stent implantation in other hospital.Conclusion Interventional diagnosis and therapy of portal hypertension resulting from hepatic vascular abnormalities are effective and accurate.It should be recommended as a first line choice to treat these diseases