超声引导下兔体内直接性门腔静脉分流支架植入术的可行性与安全性

Feasibility and safety of ultrasound-guided direct intrahepatic portacaval shunt in rabbit models

目的探讨超声引导下经皮穿刺门静脉右支(RPV)与肝后段下腔静脉(RHSIVC),行直接性门腔分流支架植入术的可行性与安全性。方法超声引导下对10只实验兔经皮穿刺RPV,调整穿刺针角度后,穿刺RHSIVC,送入导丝并沿导丝放入支架,建立直接性门腔分流通道,观察实验兔支架内血流充盈情况,并测量血流速度。术后30min解剖实验兔,观察支架位置及是否存在肝包膜下出血、腹腔大血管及周围脏器损伤等并发症。结果对9只实验兔成功实施超声引导下直接性门腔静脉分流支架植入术,另1只因术中下腔静脉出血过多致死。超声所测平均RPV内径为(0.23±0.02)cm,RHSIVC内径为(0.38±0.05)cm,RPV与RHSIVC之间平均角度为(22.38±1.60)°;平均穿刺时间(11.4±3.69)min,穿刺RPV、RHSIVC平均次数分别为(1.30±0.48)次和(1.50±0.71)次,平均支架长度(1.06±0.09)cm,支架内平均血流速度(8.14±0.89)cm/s。术后大体解剖结果显示,除1只死亡外,9只实验兔支架均位于RPV与RHSIVC之间的肝实质内,且未出现肝包膜下出血、腹腔大血管及周围脏器损伤等并发症。结论超声引导下兔体内直接性门腔静脉分流支架植入术具有一定的安全性及可行性。

Objective To investigate the feasibility and safety of creating the direct intrahepatic portacaval shunt （DIPS） between right portal vein （RPV） and retrohepatic segment of inferior vena cava （RHSIVC） under the guidance of ultra- sound. Methods Under the guidance of ultrasound, percutaneous punctures of RPV were performed in 10 rabbits. The needle was punctured into RHIVC by adjusting the impalement angle, and the the guide wire and stent were set. After es- tablishing the shunt pipe, whether the stent filled with blood was observed and the blood flow velocity in the stent was measured. Thirty minutes after operation, the rabbits were dissected to observe the position of stent and the complications, such as subcapsular hemorrhage, intraperitoneal bleeding or organ injury. Results Nine rabbits were operated successfully with creating the stent between RPV and RHSIVC. One rabbit died due to inferior vena cava hemorrhage. The average di- ameter of RPV was （0. 23±0. 02）cm and the average diameter of RHSIVC was （0.38±0.05）cm, as well as the average angle between RPV and RHSIVC was （22.38± 1.60） ° measured by ultrasound. The average time of the operation was （11.4±3.69）min, And the punctures of RPV and RHSIVC were performed 1.30±0.48 and 1.50±0. 71 times averagely. The average length of the stent was （1.06 ±0. 09）cm and the average blood flow velocity in the stent was （8.14± 0.89）cm/s. Postoperative anatomy showed the stents were set between the RPV and the RHSIVC in 9 of 10 rabbits with- out subcapsular hemorrhage, intraperitoneal bleeding or organ injury, expect the dead one. Conclusion The percutaneous punctured RPV into RHSIVC to establish the shunt pipe and seting stent is safe and feasible.