Aytekin C, Boyvat F, Firat A, Coşkun M, Boyacioğlu S
Department of Radiology, Başkent University Faculty of Medicine, 06490, Ankara, Turkey.
Abdom Imaging. 2003 Mar-Apr;28(2):287-92. doi: 10.1007/s00261-002-0032-4.
The feasibility and efficacy of portacaval shunt creation through the transhepatic and transjugular approach were evaluated in patients with portal hypertension whose hepatic venous anatomies were unsuitable for the standard shunt procedure.
Portacaval shunts were created via percutaneous transhepatic access in six patients. We used snares to target the portal vein and the inferior vena cava. Then a needle was introduced percutaneously and advanced through the snares. A guidewire was advanced through the needle and snared in the inferior vena cava. The wire was then withdrawn through the transjugular sheath. The rest of the procedure was completed in standard fashion. The transhepatic tracts were embolized.
The portacaval shunt procedures were successful in all patients. There were no major complications during the procedures, but one patient died of sepsis 1 week later. Two patients developed shunt occlusion, and in one case the shunt was revised successfully. The other patient with occlusion underwent orthotopic liver transplantation. The shunts in the remaining three patients and the revised shunt were patent at 5 to 20 months of follow-up.
Direct portacaval shunt creation using the percutaneous transhepatic and transjugular technique is a good alternative when standard portosystemic shunt creation is difficult or impossible.
对于肝静脉解剖结构不适合标准分流手术的门静脉高压患者，评估了经肝和经颈静脉途径建立门腔分流术的可行性和疗效。
通过经皮经肝途径为6例患者建立门腔分流术。我们使用圈套器定位门静脉和下腔静脉。然后经皮插入一根针并穿过圈套器推进。将一根导丝通过针推进并在下腔静脉中用圈套器套住。然后将导丝通过经颈静脉鞘管抽出。其余操作按标准方式完成。经肝通道进行了栓塞。
所有患者的门腔分流手术均成功。手术过程中无重大并发症，但1例患者在术后1周死于败血症。2例患者出现分流道闭塞，其中1例分流道成功修复。另1例闭塞患者接受了原位肝移植。其余3例患者的分流道及修复后的分流道在随访5至20个月时保持通畅。
当标准门体分流术难以或无法实施时，经皮经肝和经颈静脉技术直接建立门腔分流术是一种很好的替代方法。
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