经颈静脉肝内门体分流术治疗胆道闭锁患儿
Transjugular intrahepatic portosystemic shunts in children with biliary atresia.
作者信息
Huppert Peter E, Goffette Pierre, Astfalk Wolfgang, Sokal Emil M, Brambs Hans-Jürgen, Schott Ullrich, Duda Stephan H, Schweizer Paul, Claussen Claus D
机构信息
Department of Diagnostic Radiology, Eberhard Karls University of Tübingen, Hoppe-Seyler-Strasse 3, D-72076 Tübingen, Germany.
出版信息
Cardiovasc Intervent Radiol. 2002 Nov-Dec;25(6):484-93. doi: 10.1007/s00270-002-1913-1. Epub 2002 Nov 6.
PURPOSE
We retrospectively evaluated the technical and long-term clinical results of transjugular intrahepatic portosystemic shunts (TIPS) in children with portal hypertension and biliary atresia (BA).
METHODS
Nine children with BA and recurrent bleeding from esophagogastric and/or intestinal varices were treated by TIPS at the age of 34-156 months and followed-up in two centers. Different types of stents were used.
RESULTS
Shunt insertion succeeded in all patients, but in two a second procedure was necessary. Seven procedures lasted more than 3 hr, mainly due to difficult portal vein puncture. Variceal bleeding ceased in all patients; however, 16 reinterventions were performed in eight patients for clinical reasons (n = 11) and sonographically suspected restenosis (n = 5). Four patients underwent successful liver transplantation 4-51 months after TIPS and five are in good clinical conditions 64-75 months after TIPS.
CONCLUSION
TIPS in children with BA is technically difficult, mainly due to periportal fibrosis and small portal veins. Frequency of reinterventions seems to be higher compared with adults.
目的
我们回顾性评估了经颈静脉肝内门体分流术（TIPS）治疗门静脉高压和胆道闭锁（BA）患儿的技术及长期临床效果。
方法
9例患有BA且食管胃和/或肠静脉曲张反复出血的患儿在34至156个月龄时接受了TIPS治疗，并在两个中心进行随访。使用了不同类型的支架。
结果
所有患者均成功插入分流装置，但有2例需要进行第二次手术。7例手术持续时间超过3小时，主要原因是门静脉穿刺困难。所有患者的静脉曲张出血均停止；然而，8例患者因临床原因（n = 11）和超声怀疑再狭窄（n = 5）进行了16次再次干预。4例患者在TIPS术后4至51个月成功进行了肝移植，5例在TIPS术后64至75个月临床状况良好。
结论
BA患儿的TIPS技术难度较大，主要原因是门静脉周围纤维化和门静脉细小。与成人相比，再次干预的频率似乎更高。
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