门静脉海绵样变(CTPV)的介入治疗

 目的 总结良性病变所致门静脉海绵样变(cavernous transformation of portal vein,CTPV)介入治疗的经验及临床疗效。方法 回顾性分析2000年至2012年24例在我科行介入治疗的CTPV患者的临床资料。所有患者发病时均有不同程度的呕血、黑便或腹痛等临床症状。经颈内静脉肝内门腔分流术(transjugular intrahepatic portosystemic shunt,TIPSS)联合置管局部溶栓14例,单纯TIPSS治疗或联合冠状静脉栓塞术2例,经皮穿刺脾静脉途径门静球主干囊扩张联合TIPSS治疗1例,经皮肝穿门静脉球囊扩张2例,经皮肝穿门静脉支架植入或联合胃冠状静脉栓塞术2例,脾动脉部分栓塞术(partial splenic embolization,PSE)2例。介入手术中途停止治疗1例。随访2个月～6年,观察门静脉及分流道通畅情况并随访上消化道出血及腹痛情况。结果 随访时间内2例患者分别于术后2年及3年因TIPSS分流道狭窄或闭塞发生再次上消化道出血,行分流道修正术。1例行PSE于术后2年因上消化道出血转外科行脾切除加门奇静脉断流术;1例因无法开通闭塞的门静脉转外科行门奇静脉断流术联合分流;余所有患者未再出血或腹痛发生,门静脉或分流道通畅。结论 介入手术是一种对CTPV安全、有效、微创的治疗方法,选择合适的介入手术方法是治疗成功的关键。

Interventional treatment for cavernous transformation of portal vein(CTPV)

Objective To summarize interventional treatment for the cavernous transformation of portal vein(CTPV) induced by benign diseases. Methods Clinical data of 24 patients with CTPV treated in our hospital from year of 2000 to 2012 were retrospectively analyzed.Hematemesis,melena or abdominal pain were their main complains.Interventional treatments included:transjugular intrahepatic portosystemic shunt(TIPSS) combined transcatheter local thrombolysis performed in 14 cases,TIPSS or combined variceal embolization in 2,TIPSS combined portal vein balloon angioplasty via percutaneous spleen vein approach in 1,percutaneous transhepatic portal vein balloon angioplasty in 2,percutaneous transhepatic portal vein stent implantation combined variceal embolization in 2,partial splenic embolization(PSE) in 2,and interventional treatment aborted in 1.Blood flow in portal vein and shunt tract were observed,gastrointestinal bleeding and abdominal pain were also followed during the period from 2 months to 6 years. Results Upper gastrointestinal bleeding happened in 2 cases due to shunt tract stenosis or occlusion 2 and 3 years after treatment,respectively.Shunt tract angioplasty was then performed.Splenectomy plus porta-azygous devascularization was performed because of recurrent bleeding 2 years after PSE in 1 case.Portal systemic shunt plus porta-azygous devascularization was performed because of failure to restore the occluded portal vein in 1 case.No upper gastrointestinal bleeding and abdominal pain occurred,meanwhile patency of portal vein and shunt tract were observed in all the other cases. Conclusions Interventional treatment is safe,and effective for treatment of CTPV with minimal invasion.Rational choice of different interventional techniques is the key for successful treatment.