Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road Guangzhou, Guangdong Province, 510630, China.
J Vasc Interv Radiol. 2013 Apr;24(4):518-27. doi: 10.1016/j.jvir.2012.12.028.
To evaluate the safety and feasibility of percutaneous transsplenic portal vein catheterization (PTSPC) by retrospective review of its use in patients with portal vein (PV) occlusion.
From July 2004 to December 2010, 46 patients with a history of uncontrolled gastroesophageal variceal bleeding secondary to portal hypertension underwent endovascular PV interventions via a percutaneous transsplenic approach. All patients had occlusion of the main PV or central intrahepatic PV branches, which prevented the performance of a transhepatic approach. A vein within the splenic parenchyma was punctured under fluoroscopic guidance by referencing preoperative computed tomography images. PTSPC-related complications and clinical applications were analyzed.
PTSPC was successfully performed in 44 of 46 patients (96%); two failures were caused by inaccessible small intrasplenic veins. PTSPC-related major bleeding complications occurred in three patients (6.5%), including large intraperitoneal hemorrhage in one patient and large splenic subcapsular hemorrhage in two patients. Two of the three patients developed hypotension, and one developed severe anemia. All three of the patients required blood transfusions. PTSPC-related minor bleeding complications occurred in six patients (13%) as a result of a small splenic subcapsular hemorrhage. In addition, three patients exhibited mild left pleural effusion, which subsided spontaneously 1 week later. All 44 patients successfully treated via PTSPC received gastroesophageal variceal embolization. Eight patients received PV stents, five for treatment of PV occlusion and three during transjugular intrahepatic portosystemic shunt placement.
PTSPC is a safe and effective access for endovascular PV interventions in patients without a transhepatic window.
通过回顾性分析经皮经脾门静脉穿刺（PTSPC）在门静脉（PV）阻塞患者中的应用，评估其安全性和可行性。
2004 年 7 月至 2010 年 12 月，46 例因门静脉高压导致的胃食管静脉曲张出血失控的患者，采用经皮经脾途径进行血管内 PV 介入治疗。所有患者均存在主 PV 或中央肝内 PV 分支阻塞，无法进行经肝途径。在透视引导下，参照术前 CT 图像，在脾实质内的静脉进行穿刺。分析 PTSPC 相关并发症和临床应用。
46 例患者中有 44 例（96%）成功进行了 PTSPC；2 例失败是由于脾内小静脉无法到达。3 例（6.5%）患者出现 PTSPC 相关大出血并发症，包括 1 例患者发生大量腹腔内出血和 2 例患者发生大脾包膜下出血。其中 2 例患者出现低血压，1 例出现严重贫血。所有 3 例患者均需输血。6 例（13%）患者因小脾包膜下出血出现 PTSPC 相关轻微出血并发症。此外，3 例患者出现轻度左侧胸腔积液，1 周后自行消退。所有 44 例患者通过 PTSPC 成功接受了胃食管静脉曲张栓塞治疗。8 例患者接受了 PV 支架治疗，5 例用于治疗 PV 阻塞，3 例用于经颈静脉肝内门体分流术（TIPS）。
对于没有经肝途径的患者，PTSPC 是一种安全有效的血管内 PV 介入治疗入路。
