单导丝门静脉定位技术在经颈静脉肝内门体分流术中的应用

Portal vein localization technique with a single guidewire during TIPS

目的探讨单导丝门静脉定位技术辅助经颈静脉肝内门体分流术(TIPS)中肝内门静脉穿刺的有效性和安全性。方法连续收集2017年1月至2018年8月因肝硬化门静脉高压症接受单导丝门静脉定位辅助TIPS治疗的12例患者临床资料。术前通过门静脉CTV评估门静脉解剖并预先选定肝内门静脉穿刺点。术中在彩色超声导引下采用21 G Chiba针经皮经肝穿刺肝内门静脉分支,引入0.014英寸导丝并将其远端置入脾静脉,再以导丝为靶向经肝静脉穿刺门静脉左支或右支主干,穿刺成功后完成后续TIPS操作;术毕拔除门静脉定位导丝,无需封堵穿刺道。观察评估门静脉穿刺次数、穿刺成功率及穿刺相关并发症。结果12例TIPS患者肝内门静脉穿刺均获成功。其中8例经Ⅲ段门静脉分支入路放置细导丝导向经肝静脉穿刺门静脉左支主干建立分流道,4例经Ⅷ段门静脉分支入路放置细导丝导向经肝静脉穿刺门静脉右支主干建立分流道。平均穿刺次数为(1.25±0.45)次(1~2次),术后患者均未出现门静脉穿刺相关并发症。结论采用单导丝定位门静脉辅助TIPS术中门静脉穿刺技术操作简便、安全有效,适用于TIPS分流道穿刺高风险患者。

Objective To evaluate the efficacy and safety of portal vein localization technique with a single guidewire in assisting the puncture of portal vein during the performance of transjugular intrahepatic portosystemic shunt (TIPS).Methods The clinical data of 12 consecutive patients,who were admitted to authors' hospital during the period from January 2017 to August 2018 to received portal vein localization technique with a single guidewire to assist the puncture of portal vein during the performance of TIPS,were collected.Before TIPS,CT venography (CTV) of portal vein was performed to observe the portal venous anatomy and to determine the optimal puncture point for portal vein.During TIPS,under color ultrasonic guidance percutaneous transhepatic puncture of intrahepatic portal vein with a 21G Chiba needle was carried out,and a 0.014 inches guidewire was introduced into the portal vein with its distal end positioning in the splenic vein.Using the guidewire as the target,the left branch or right branch trunk of portal vein was punctured via hepatic vein,which was followed by subsequent TIPS procedures.At the end of TIPS,the portal vein localization guidewire was removed and there was no need to occlude the puncture tract.The number of puncturing portal vein,success rate of puncture,and puncture- related complications were calculated, and the results were evaluated.Results Intrahepatic portal vein puncture was successfully performed in all 12 patients undergoing TIPS.The intrahepatic shunt was created by puncturing left portal vein trunk via hepatic vein under the guidance of a fine guidewire that was placed in the hepatic vein through a portal vein branch in hepatic Ⅲ segment (n=8),or was created by puncturing right portal vein trunk via hepatic vein under the guidance of a fine guidewire that was placed in the hepatic vein through a portal vein branch of hepatic Ⅷ segment(n=4).The average number of puncturing portal vein was(1.25±0.45) times (1- 2 times). After TIPS,no portal vein puncture- related complications occurred in all patients.Conclusion For assisting the puncture of portal vein during the performance of TIPS,the portal vein localization technique with single guidewire is simple,safe and effective,which is suitable for patients with high risk of TIPS shunt puncture.