DSA在儿童先天性肝外门体静脉分流的临床分型及治疗中的应用价值

Application Value of DSA in the Clinical Classification and Treatment of Children's Congenital Extrahepatic Portosystemic Shunts

目的探讨数字减影血管造影(Digital Subtraction Angiography,DSA)在儿童先天性肝外门体静脉分流的临床分型及治疗中的重要价值。方法回顾性分析15例先天性肝外门体静脉分流患儿的DSA结果并与临床资料进行对比。结果 15例患儿经过DSA检查得到明确诊断及临床分型,Ⅰ型2例,1例Ⅰ型患儿行肝移植,1例随访中;Ⅱ型13例,Ⅱ型中除1例随访外,其余12例均得到有效治疗,其中4例在DSA下对异常侧枝血管进行plug封堵器封堵,8例在确诊后因无法封堵而进行及时有效的外科门体静脉断流术。治疗后患儿临床症状明显得到改善。结论 DSA是确诊先天性门-体静脉分流类型一种敏感而准确的方法,尤其能检测到易被常规CT/MRI漏诊的肝内细小的门静脉分支而纠正分型,从而争取及时有效的治疗机会。

Objective This paper aimed to explore the value of digital subtraction angiography(DSA)inthe clinical classification and treatment of children's congenital extrahepatic portosystemic shunts(CEPS).Methods The DSA results of15cases of congenital hepatic portal vein were analyzed retrospectively aswell as being compared with the clinical data.Results Fifty cases were diagnosed and classified by DSA,which contained2cases of typeⅠand13cases of typeⅡ.For the13cases of typeⅡ,12cases weretreated effectively except1case was followed-up.4cases with abnormal sido veins were plugged underDSA,the other8cases could not undergone the ligating the portosystemic shunts surgery effectivelybecause they could not be plugged well.The clinical symptoms of the children were significantlyimproved after treatment.Conclusion DSA is a sensitive and accurate way to make a definite diagnosisfor CEPS,especially in modifying the classification of patients which are always misdiagnosed by routineCT/MRI due to not detecting tiny branch of intrahepatic portal vein,and provides timely and effectivetreatment opportunities for these patients.