提高经颈静脉肝内门体分流术治疗门静脉闭塞技术成功率的辅助靶标手段

The auxiliary target means used for improving the success rate of TIPS in treating portal vein occlusion

目的 探讨提高经颈静脉肝内门体分流术(TIPS)治疗门静脉闭塞(PVO)技术成功率的辅助靶标手段及其安全性和有效性。方法 纳入22例应用辅助靶标手段行TIPS治疗的PVO患者。其中11例应用经皮经肝门静脉靶标(PTPVT)技术,10例应用肝动脉导丝靶标(HAT)技术,1例两种辅助手段联合应用。结果 1例失败,技术成功率为95.5%(21/22)。成功建立分流道患者门静脉压力梯度(PPG)由(28.4±7.7) mmHg(1 mmHg=0.133 kPa)降至(12.1±4.5) mmHg(P<0.01)。术中未出现危及生命的严重并发症。中位随访时间14.9个月,术后累积支架通畅率为81.8%(18/22);6例发生静脉曲张再出血,累积再出血率为27.3%;3例出现肝性脑病;1例因发生感染死亡。结论 TIPS是治疗PVO的安全有效方法,辅助靶标手段可提高TIPS的技术成功率。

Objective To discuss the safety and efficacy of auxiliary target means for improving the success rate of transjugular intrahepatic portosystemic shunt(TIPS) in treating portal vein occlusion(PVO).Methods A total of 22 PVO patients, who received TIPS with the help of auxiliary target means, were retrospectively collected. Of the 22 patients, 11 received TIPS with the help of percutaneous transhepatic portal vein target(PTPVT) technique, 10 received TIPS with the help of hepatic artery guide-wire target(HAT) technique,and one received TIPS with the help of combination use of PTPVT and HAT techniques. Results The procedure failed in one patient, the technical success rate was 95.5%(21/22). The mean portal pressure gradient(PPG)in the patients, in whom the portosystemic shunt was successfully established, remarkably decreased from preoperative(28.4±7.7) mmHg to postoperative(12.1±4.5) mmHg(P<0.01). During the operation, no serious life-threatening complications occurred. The median follow-up time was 14.9 months. The postoperative cumulative stent patency rate was 81.8%(18/22). Six patients developed re-bleeding of varicose vein, and the cumulative re-bleeding rate was 27.3%. Three patients(13.6%) developed hepatic encephalopathy. One patients(4.5%) died of infection. Conclusion For the treatment of PVO, TIPS is clinically safe and effective, and auxiliary target means can improve the success rate of TIPS.