经肠系膜静脉肝外门体分流术在治疗门静脉海绵样变性伴症状性门静脉高压症中的应用
Application of transmesenteric vein extrahepatic portosystemic shunt in treatment of symptomatic portal hypertension with cavernous transformation of portal vein.
作者信息
Li Weixiao, Cui Mingzhe, Li Qiang, Zhang Kewei, Zhai Shuiting, Li Tianxiao, Nick Cheshire, Li Xiuling, Wang Heng, Zhu Yadong, Lu Danghui, Chen Jiangbo
机构信息
Department of Vascular and Endovascular Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China.
Department of Medical Imaging, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China.
出版信息
J Interv Med. 2023 Apr 21;6(2):90-95. doi: 10.1016/j.jimed.2023.04.001. eCollection 2023 May.
PURPOSE
To evaluate the feasibility and efficacy of a transmesenteric vein extrahepatic portosystemic shunt (TmEPS) for the treatment of cavernous transformation of the portal vein (CTPV).
MATERIALS AND METHODS
The clinical data of 20 patients with CTPV who underwent TmEPS between December 2020 and January 2022 at Henan Provincial People's Hospital were retrospectively collected. The superior mesenteric vein (SMV) trunk was patent or partially occluded in these patients. An extrahepatic portosystemic shunt between the inferior vena cava and the SMV was established using a stent graft through an infraumbilical median longitudinal mini-laparotomy. The technical success, efficacy, and complication rates were evaluated, and the pre- and postoperative SMV pressures were compared. Patients' clinical outcomes and shunt patency were assessed.
RESULTS
TmEPS was successfully performed in 20 patients. The initial puncture success rate of the balloon-assisted puncture technique is 95%. The mean SMV pressure decreased from 29.1 ± 2.9 mmHg to 15.6 ± 3.3 mmHg (p < 0.001). All symptoms of portal hypertension resolved. No fatal procedural complications occurred. During the follow-up period, hepatic encephalopathy occurred in two patients. The remaining patients remained asymptomatic. All shunts were patent.
CONCLUSIONS
TmEPS is a feasible, safe, and effective treatment option for patients with CTPV.
目的
评估经肠系膜静脉肝外门体分流术（TmEPS）治疗门静脉海绵样变性（CTPV）的可行性和疗效。
材料与方法
回顾性收集2020年12月至2022年1月在河南省人民医院接受TmEPS治疗的20例CTPV患者的临床资料。这些患者的肠系膜上静脉（SMV）主干通畅或部分闭塞。通过脐下正中纵行小切口，使用覆膜支架在腔静脉和SMV之间建立肝外门体分流。评估技术成功率、疗效和并发症发生率，并比较术前和术后SMV压力。评估患者的临床结局和分流通畅情况。
结果
20例患者成功实施TmEPS。球囊辅助穿刺技术的首次穿刺成功率为95%。平均SMV压力从29.1±2.9 mmHg降至15.6±3.3 mmHg（p<0.001）。所有门静脉高压症状均得到缓解。未发生致命的手术并发症。随访期间，2例患者发生肝性脑病。其余患者无症状。所有分流均通畅。
结论
TmEPS是治疗CTPV患者的一种可行、安全且有效的治疗选择。
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