直接肝内门体分流术治疗难治性肝性胸水：一例报告
Direct intrahepatic portocaval shunt for refractory hepatic hydrothorax: a case report.
作者信息
Kawahara Yo, Tanaka Yoshihiro, Isoi Naoaki, Hatanaka Kohsuke, Yamada Kentaro, Yamamoto Masayoshi, Okamura Teppei, Kaji Tatsumi, Sakamoto Toshihisa, Saitoh Daizoh, Ikeuchi Hisashi
机构信息
Department of Traumatology and Critical Care Medicine National Defense Medical College Saitama Japan.
Department of Radiology National Defense Medical College Saitama Japan.
出版信息
Acute Med Surg. 2016 Dec 9;4(3):306-310. doi: 10.1002/ams2.257. eCollection 2017 Jul.
CASE
A 64-year-old man with complaints of dyspnea and orthopnea secondary to a hepatic hydrothorax refractory to diuretic medication underwent the transjugular intrahepatic portosystemic shunt (TIPS) procedure to decrease the portal vein pressure. The TIPS procedure failed due to severe liver stiffness. Direct intrahepatic portocaval shunt (DIPS), a modified TIPS procedure that directly inserts a stent from the inferior vena cava to the portal vein, was successfully carried out.
OUTCOME
The DIPS procedure significantly decreased the patient's pleural effusion and respiratory symptoms.
CONCLUSION
No other medical treatment is available to control refractory pleural effusion caused by portal hypertension; however, the TIPS (or DIPS) procedure can be successfully carried out in patients <60 years old with a Model of End-Stage Liver Disease score <15.
病例
一名64岁男性，因肝性胸水导致呼吸困难和端坐呼吸，对利尿剂治疗无效，接受经颈静脉肝内门体分流术（TIPS）以降低门静脉压力。由于肝脏严重硬化，TIPS手术失败。直接肝内门腔分流术（DIPS）是一种改良的TIPS手术，直接从下腔静脉向门静脉插入支架，手术成功实施。
结果
DIPS手术显著减轻了患者的胸腔积液和呼吸症状。
结论
对于门静脉高压引起的顽固性胸腔积液，没有其他可用的药物治疗方法；然而，终末期肝病模型评分<15的<60岁患者可以成功实施TIPS（或DIPS）手术。
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