经颈静脉途径介入治疗门静脉阻塞

Interventional therapy for portal vein occlusion through jugular vein route

目的评价经颈静脉途径介入治疗门静脉阻塞的可行性和安全性。方法 16例门静脉阻塞患者,腹水合并上消化道出血12例,单纯腹水4例;透视引导下应用RUPS-100肝穿装置经右颈内静脉入路穿刺门静脉,成功后引入导丝使其通过门静脉狭窄闭塞段,通过机械性抽吸、接触性药物溶栓、球囊扩张或支架植入等技术开通阻塞的门静脉,并用支架建立肝内门体分流通路。结果 11例(68.7%)患者门静脉被开通并建立了肝内门体分流通路,门静脉开通前后阻塞远端压力由(4.98±0.61)kPa降至(2.40±0.24)kPa,8例经治疗后呕血黑便消失,7例腹水明显吸收,1例术后5天出现肝性脑病,经治疗后缓解,2例在术后3个月、9个月出现分流道闭塞,经置管溶栓及球囊扩张后再通。结论经颈静脉途径介入治疗门静脉阻塞技术可行,对于内科保守治疗无效又不适宜手术治疗的患者,应考虑选用本项技术。

Objective To evaluate the efficacy and safety of interventional radiological technique through jugular vein route for management of portal vein occlusion.Methods Sixteen patients with portal vein occlusion were treated using interventional radiological technique by jugular vein route.Indications were ascites and esophageal variceal bleeding（n=12）,ascites（n=4）.At first,puncture was performed in the portal vein system using rups-100 TIPS set through right internal jugular vein,then a hydrophilic wire was required to negotiate accross the portal vein occlusion.The portal vein clot was removed by mechanical aspiration or directly pharmacologic thrombolysis,the intrahepatic portosystemic shunt was created with a balloon and Wallstent.Results The technical success rate was 68.7%（11/16）.The portal vein pressure prior to recanalization was（4.98±0.61） kPa,after recanalization（2.40±0.24） kPa.The ascites（n=7） were controlled effectively,the hematemesis and melena（n=8） disappeared,one patient suffered from hepatic encephalopathy at 5 days postoperation,two patients suffered from shunt reocclusion at 3,9 months postoperation,and by duct thrombolysis and balloon distension,the occlusions reopened.Conclusion The interventional radiological technique through jugular vein route for management of portal vein occlusion was significantly effective and safe,it might be a treatment option in certain patients whose clinical symptoms could not be controlled by medical conservative treatment,or were not surgery indication,too.