摘要
目的探讨超声引导经皮肝穿刺门静脉造影改良经颈内静脉肝内门体分流术(TIPS)的临床疗效,提高其穿刺准确性和安全性。方法回顾性分析空军总医院2010年7月至2011年10月采用经皮肝穿刺门静脉造影改良TIPS技术治疗门静脉高压所致急性上消化道出血23例患者的临床资料。超声引导下经皮经肝穿刺门静脉右支,成功后将Cobra导管置入门静脉进行造影、栓塞胃冠状静脉、测压,然后将Cobra导管置于门静脉,进行门静脉正侧位造影,引导Rups-100穿刺门静脉。球囊扩张肝实质分流道,置入金属支架,陈旧性血栓用金属支架旷置,造影测压。结果 23例患者均成功实施TIPS手术,上消化道出血即刻得到控制,手术时间(140.32±43.56)min、手术开始至胃冠状静脉封堵时间(12.53±13.18)min、穿刺针数(4.16±2.73)针、TIPS治疗可显著降低门静脉压力,TIPS治疗前后血氨无显著变化。结论超声引导下经皮肝穿刺门静脉造影改良TIPS,可标识定位指导TIPS操作,并可在第一时间封堵胃冠状静脉出血,提高了TIPS穿刺的准确性和安全性。
Objective To study clinical efficacy of improved TIPS by percutaneous portal vein puncture for enhancing its accuracy and safety. Methods 23 cases of portal hypertension with acute upper gastrointestinal bleeding reformed percutaneous portal vein puncture improved TIPS from 2010 to 2011 at Air Force General Hospital of Chinese PLA were investigated retrospectively. The right portal branch was punctured under ultrasonic guidance. Then the Cobra catheter was put into the portal vein for portography, the gastric coronal vein was embolized and portal pressure was measured. The Cobra catheter was detained in the portal vein for portography of anterior and lateral position. The Rups-100 was guided under the Cobra catheter during the TIPS puncture procedure. The balloon was used to dilate the parenchyma channel and then the metal stent was released smoothly. To ensure the effectiveness, portography was made and portal pressure was measured again. Results All cases reformed portal vein puncture improved TIPS successfully, acute upper gastrointestinal bleedings were controlled immediately. Operative time was （140. 32 ± 43.56）rain, time from the beginning of operation to gastric coronary vein occlusion was （12. 53 ± 13.18 ） min, the number of puncture was 4. 16 ± 2. 73. TIPS can reduce portal pressure significantly. No significant difference was observed in blood ammonia before and after TIPS. Conclusions Ultrasound-guided pereutaneous portal vein puncture angiography can guide TIPS operation, control gastric coronary vein bleeding at once, and improve the accuracy and safety of TIPS.
出处
《中华临床医师杂志（电子版）》
CAS
2012年第7期35-38,共4页
Chinese Journal of Clinicians(Electronic Edition)
作者简介
通讯作者：张洪义，Email：zhanghongyi66@163.com
