经颈内静脉建立肝外门腔分流道的可行性研究

The feasibility study of transjugular extrahepatic portacaval shunt

目的探索X射线引导下经颈内静脉路径从下腔静脉直接穿刺肝外门静脉主干,建立肝外门腔分流道的可行性及安全性。方法 6头健康家猪,超声引导下经皮经肝路径,置入5F猪尾导管于门静脉主干作靶导管。超声引导下经颈内静脉路径,置入RUPS-100穿刺系统于下腔静脉。X射线引导下,从下腔静脉穿刺靶导管,以Fluency覆膜支架建立肝外门腔分流道,行分流道造影。术后3 d及2周,行全腹部增强CT评估分流道通畅情况及腹腔出血情况。结果 6头健康家猪均一针穿刺成功并建立肝外门腔分流道,6头术中分流道造影均无对比剂外溢;1头于手术当天死于麻醉过量,2头于术后3 d分流道失效(1头分流道闭塞,另1头狭窄80%)。另3头于术后2周分流道闭塞。6头尸检证实分流道均位于肝外且无腹腔出血。结论 X射线引导下经颈内静脉建立肝外门腔分流道是安全、可行的。

Objective To evaluate the feasibility of X-ray guided access to the extrahepatic segment of the main portal vein （PV） to create a transjugular extrahepatic portacaval shunt （TEPS）. Methods 5F pigtail catheter was inserted into the main PV as target catheter by percutaneous transhepatic path under ultrasound guidance. The RUPS-100 puncture system was inserted into the inferior vena cava （IVC） by transjugular path under ultrasound guidance. Fluency covered stent was deployed to create the extrahepatic portacaval shunt after puncturing the target catheter from the IVC under the X-ray guidance, then shunt venography was performed. Enhanced CT of the abdomen helped identify and quantify the patency of the shunt and the presence ofhemoperitoneum. Results The extrahepatic portacaval shunts were created successfully by only 1 puncture in 6 pigs. No extravasation was observed in shunt venography. One pig died of anesthesia on the day of operation. The extrahepatic portacaval shunts were failed in 2 pigs 3 days after the operation （one was occluded and the other one was narrowed by 80%）. The extrahepatic portacaval shunts were occluded 2 weeks after the operation in the remaining 3 pigs. The shunts were out of the liver and no hemoperitoneum was identified at necropsy in the 6 pigs. Conclusion TEPS is technically safe and feasible under the X-ray guidance.