门体限制性分流术后分流道狭窄或闭塞腔内治疗(附24例分析)

Endovascular treatment for shunt stenosis or occlusion after restricted portosystemic shunt:An analysis of 24 cases

目的探讨门体限制性分流术（肠系膜上静脉-下腔静脉人工血管分流术简称肠腔分流术，脾静脉-下腔静脉人工血管分流术简称脾腔分流术）后人工血管分流道狭窄或者闭塞的原因，分析经皮穿刺血管腔内治疗的可行性及疗效。方法回顾性分析2009年3月至2012年3月郑州大学第一附属医院腔内血管外科对门静脉高压症病人行门体限制性分流术后人工血管分流道狭窄或闭塞24例（肠腔分流术19例，脾腔分流术5例）临床资料。结果24例门静脉高压症门体限制性分流术后分流道狭窄或闭塞的病人中，7例为术后1周内分流道急性血栓形成，均给予血管内置管接触溶栓术；9例为术后1—8年出现分流道狭窄，均为人工血管-肠系膜上静脉吻合口狭窄，给予球囊扩张或（和）支架成形；8例为术后1～4年出现分流道闭塞，成功开通6例，行球囊扩张或（和）支架成形。失败2例，均为导丝导管无法通过人工血管-下腔静脉吻合口。同期行胃冠状静脉或（和）胃短静脉栓塞者13例。治疗成功者术后症状改善明显。结论应用经皮穿刺通过“股静脉-下腔静脉-人工血管-门静脉”途径血管腔内治疗（置管接触溶栓治疗、球囊扩张、支架置入等）门体限制性分流术后，分流道狭窄或闭塞病人创伤小，成功率高，疗效显著。

Objective To explore the cause of artificial vessel stenosis or occlusion after restricted portosystemic shunt （mesocaval shunt was short for superior mesenteric vein-inferior vena cava shunt; spleen shunt was short for splenic vein-inferior vena cava shunt）, and analysis the feasibility and efficacy of percutaneous endovascular therapy. Methods The clinical data of 24 cases of artificial vessel stenosis or occlusion after restricted portosystemic shunt for portal hypertension from March 2009 to March 2012 in Department of Endovascular Surgery, the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively （19 cases of mesocaval shunt, 15 cases of spleen shunt）. Results In the 24 cases of artificial vessels stenosis or occlusion treated by restricted portosystemic shunt for portal hypertension, 7 cases who got acute thrombosis within a week after the surgery were treated by catheter directed thrombolysis; 9 cases who got shunts stenosis for anastomotic stenosis of artificial vessel-superior mesenteric vein from 1 to 8 years after surgery were cured by balloon dilatation or stent angioplasty. The shunts artificial vascular occlusion occurred in 8 cases from 1 to 4 years after surgery, 6 of whom succeed to be patent by balloon dilatation or stent angioplasty, and 2 cases were failed for the guide wire can＇ t go through the anastomotic site of artificial vessel-superior mesenteric vein. And 13 cases were associated with embolism of esophagogastric varices for postoperative standard anticoagulation. Conclusion Endovascular therapy by percutaneous puncture through ＂femoral vein-inferior vena cava-artificial vessel-portal vein＂ （including catheter directed thrombolysis, balloon dilatation, stent placement ,etc） are little trauma, highly successful and have a remarkable effect in the treatment of shunt stenosis or occlusion after restricted portosystemic shunt in portal hypertension