布加综合征的直接肝内腔静脉-门静脉分流术：同步荧光透视和经腹超声检查的作用
Direct intrahepatic cavo-portal shunts in Budd-Chiari syndrome: Role of simultaneous fluoroscopy and trans-abdominal ultrasonography.
作者信息
Keshava Shyamkumar N, Kota Gopi Krishna, Mammen Thomas, Jeyamani R, Moses Vinu, Govil Shalini, Kurian George, Chandy George
机构信息
Department of Radiology, Christian Medical College and Hospital, Vellore 632 004, India.
出版信息
Indian J Gastroenterol. 2006 Sep-Oct;25(5):248-50.
BACKGROUND
Transjugular intrahepatic porto-systemic shunt (TIPS) for Budd-Chiari syndrome (BCS) can be inserted from inferior vena cava or hepatic vein to portal vein. The former is performed when hepatic veins are not suitable and is technically more challenging.
METHODS
In this retrospective study, 7 patients with chronic BCS needed cavo-portal shunt as hepatic veins were neither amenable to plasty nor provided access for TIPS placement. Simultaneous fluoroscopic and trans-abdominal ultrasound guidance was used at the time of portal vein puncture.
RESULTS
Technical success and clinical improvement were obtained in all patients. Median 3 (range 1-4) attempts were needed to puncture the portal vein. There were no significant complications. Uncovered stents were used in six patients and stent occlusion was common, but could be managed by re-intervention.
CONCLUSION
Cavo-portal shunt is an effective technique for patients with BCS uncontrolled by medical therapy. Additional trans-abdominal ultrasound in oblique parasagittal plane keeps the procedure safe.
背景
布加综合征（BCS）的经颈静脉肝内门体分流术（TIPS）可从下腔静脉或肝静脉插入至门静脉。当肝静脉不适合时采用前者，其技术难度更大。
方法
在这项回顾性研究中，7例慢性BCS患者因肝静脉既不适合成形术也无法为TIPS置入提供入路，需要进行腔门静脉分流术。门静脉穿刺时同时采用荧光透视和经腹超声引导。
结果
所有患者均获得技术成功和临床改善。门静脉穿刺平均需要3次（范围1 - 4次）尝试。无明显并发症。6例患者使用了裸支架，支架闭塞很常见，但可通过再次干预处理。
结论
腔门静脉分流术是治疗药物治疗无法控制的BCS患者的有效技术。在斜矢状旁平面增加经腹超声可确保手术安全。
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