部分脾栓塞术对肝硬化门脉高压症患者肝,脾血流的影响

应用彩色多普勒血流显像技术观察11例肝硬化门脉高压症患者行部分脾栓塞术(PSE)后,肝脾血流变化的结果。患者脾动脉、脾静脉和门静脉的内径、血流速度和血流量较术前显著缩小和下降(P<0.05～0.001),门静脉血流量减少的程度与脾动脉血流量的变化呈正相关(r=0.8635).彩色多普勒血流显像检查为判断 PSE 的疗效和栓塞剂的合理用量提供了重要的影像学依据.     

经皮胃冠状静脉栓塞术联合部分脾栓塞术在门静脉高压症治疗中的应用

目的探讨一种联合介入术式在治疗门脉高压症中的地位与作用。方法对30例高危门脉高压患者随机分组,A组15例行经皮胃冠状静脉栓塞术(PTVE)联合部分脾栓塞术(PSE),B组15例行单纯PSE术,术前、术后分别采用多普勒超声检查门静脉侧支循环情况,对两组进行比较。结果两组脾功能亢进均得到缓解,联合术式患者曲张静脉全部得到栓塞,A组术前、术后门脉内径无明显变化,术后血流速度减慢,血流量降低(P<0.05),奇静脉内径变小(P<0.01),血流量下降(P<0.01),血流速度降低(P<0.01);B组门脉管径变小,流速降低,流量下降(P<0.01),但奇静脉管径无明显改变,流速降低,流量下降。两组奇静脉血流量下降幅度有明显差异(P<0.01),两组随访13～16个月,B组出现食管胃底曲张静脉破裂出血2例,继发性门脉血栓形成1例,而A组未再出现食管胃底曲张静脉破裂出血,但出现门脉高压性胃肠病(PHG)2例(均有胃镜证实)。结论联合术式能有效治疗门脉高压食管胃底曲张静脉破裂出血和脾功能亢进,该方法操作相对简单,侵袭性小,尤其适用于肝功能差难以耐受外科分流及断流手术的患者,具有临床推广价值。     

部分脾栓塞治疗术后的并发症及处理

部分脾栓塞术(Partial Splenec Embolization,PSE)是目前治疗肝炎后肝硬化并发门脉高压及脾功能亢进症的有效方法。本院自1998年以来对21例该类患者行了PSE,术后患者的脾功能亢进得到缓解,门脉高压亦有一定程度地降低。本文旨在探讨其术后并发症的发生和处理。     

介入断流术后门静脉动力学动态变化研究

目的:观察介入断流术后门静脉系统血流动力学动态变化。方法:对106例介入断流术病人术中测门静脉压力,术前及术后检测门静脉系统血流动力学及相关指标。结果:术后自由门静脉压(32.98±7.20cmH2O)较术前(38.44±7.40cmH2O)明显降低,平均下降14.20%,术后1周门静脉、脾静脉、肠系膜上静脉血流量(分别为797.11±309.55ml/min、643.40±304.58ml/min、737.18±258.00ml/min)较术前(分别为993.53±409.92ml/min、900.41±317.83ml/min、807.90±287.98ml/min)明显下降,而后逐渐回升,术后半年门静脉血流量(840.99±331.46ml/min)较术前无显著差异。结论:介入断流术即胃冠状静脉TH胶栓塞 部分脾动脉栓塞能有效地降低门静脉压力及门静脉血流量,为食管胃底静脉曲张的临床治疗提供理论依据。     

部分脾栓塞术治疗肝硬化门脉高压症肝、脾血流动力学远期变化

目的 观察肝硬化并发门脉高压症和脾功能亢进(脾亢)患者行部分脾栓塞(PSE)后肝、脾血流动力学的远期变化.方法 对1 720例肝硬化并发门静脉高压症和脾亢患者行PSE,观察其1～5年病死率,分析其死亡原因,对生存期达5年以上且资料完整的600例患者观察术前及术后肝、脾血流动力学及血象、脾脏大小、并发症等变化.结果 PSE后不同时期血流动力学具有明显变化,消化道出血次数和量明显减少;白细胞及血小板较术前明显上升;术后2个月脾脏开始逐渐缩小,3个月后明显缩小.差异有统计学意义(P<0.01).结论 PSE可明显改善肝、脾血流动力学,降低门脉压力,改善脾亢症状,减少消化道出血机会,延长生存期,改善生活质量,远期疗效显著且稳定,是一种创伤小、并发症少、安全、有效的技术.     

门静脉高压部份脾栓塞的经验

作者对5例门静脉压增高病人作了部分脾栓塞(PSE),其中特发性门脉高压(IPH)2例,肝硬化(LC)3例。按Seldinger法将导管插入脾门附近的脾动脉内,用明胶海绵细片进行脾动脉栓塞。脾脏栓塞范围应由透视下确认脾动脉血流减少后摄影,观察脾实质影象决定,原则上应栓塞50％以下,但对特发性门静脉高压者可酌增。术后定期观察血小板数(PLTS),WBC,Hb。作者见到,     

部分性脾栓塞术改变门脉血流动力学的定量研究

目的　研究部分性脾栓塞术 (PSE)前、后门脉血流及压力的改变。方法　 31例临床确诊肝硬化脾功能亢进的患者经股动脉穿刺行部分性脾栓塞术 ,术前及术后彩色多普勒超声 (简称彩超 )观测门静脉主干 (PV)、脾静脉主干 (SV)、肠系膜上静脉主干 (SMV)的血流改变情况 ,1 1例栓塞前后经皮经脾穿刺脾静脉分别置管于PV、SV、SMV测压。结果　 31例患者PSE术后PV、SV及SMV血流量较术前明显减少 (P <0 0 5) ;PV、SV血流量减少程度与栓塞程度呈正相关 ,r值分别为 0 589、0 862 ,P值均 <0 0 1。 1 1例患者 (栓塞程度 60 %～ 80 % )栓塞前后测压结果表明栓塞后PV、SV、SMV的压力均较术前明显降低 (P <0 0 0 1 ) ;PV、SV、SMV的压力下降程度分别为 (2 2 2± 5 8) %、(2 8 5± 1 7) %、(1 9 5± 8 1 ) % ,且PV、SV压力降低程度与栓塞程度呈正相关 ,r值分别为 0 645、0 687,P值均 <0 0 5。结论　栓塞面积控制在 60 %～ 80 %可较好的改善肝硬化脾功能亢进患者的外周血象 ,减少门脉血流量和降低门脉压力 ,减轻食管、胃底静脉曲张程度     

经皮胃冠状静脉栓塞联合部分脾栓塞术治疗门静脉高压症

目的:探讨联合介入术在治疗门静脉高压症中的作用。方法:对50例高危门脉高压患者随机分组,A组25例行胃冠状静脉栓塞术(PTVE)联合部分脾栓塞术(PSE),B组25例行单纯PSE术,所有患者于术前和术后分别行彩色多普勒和测压导管检查了解门静脉侧支循环、门静脉压力,对两组的各项指标进行对比分析。结果:两组行介入术后脾功能亢进均得到缓解,采用联合介入术式的患者曲张静脉全部得到栓塞;A、B两组术前、术后门静脉内径均变小,血流速度减慢,两者差异无统计学意义(P>0.05),但B组门静脉压力减低较A组明显(P<0.05);A组奇静脉内径变小,血流速度减慢(P<0.05),B组奇静脉内径无变化,流速减慢,两组间奇静脉血流量下降幅度有明显差异(P<0.01)。结论:联合介入术能有效治疗门脉高压食管胃底曲张静脉破裂出血和脾功能亢进,该方法侵袭性小,适用于肝功能差不能耐受外科手术的患者,具有较高的临床应用价值。     

21例部分脾栓塞术病人的护理

部分脾栓塞术是目前治疗肝炎后肝硬化并发门脉高压及脾功能亢进症的有效方法。由于肝炎后肝硬化并发门脉高压及脾功能亢进症的病人病情较为复杂 ,部分脾栓塞治疗术后 ,常出现一些严重的症状 ,也可能发生较为严重的并发证 ,因此 ,对该类病人进行行之有效的护理对手术的成功起关键的作用。本院自 1998年来对 2 1例该类患者行部分脾栓塞术 ,取得了较好临床效果。现对该病的护理体会报告如下 :1　临床资料　　 2 1例患者中 ,男 18例 ,女 3例 ;年龄 2 6岁～ 6 7岁 ,平均 4 0 1岁。均诊断为“肝炎后肝硬化并发门脉高压及脾功能亢进症”。肝功能按…     

门脉高压性胃病的发病机制和诊治研究进展

门脉高压性胃病 (portalhypertensivegastropa thy ,PHG)是指门脉高压症伴发的胃黏膜病变 ,主要发生于肝硬化门脉高压症病人 ,也见于非肝硬化门脉高压症病人 ,临床主要表现为消化道出血等症状 ,严重时危急生命。作者就PHG的发病机制及诊治进展作一综述。1　发病机制1 1　胃血管血流动力学改变　多数认为 ,PHG时胃的总血流量增加 ,但胃血流分布发生变化。黏膜层的血流量相对减少 ,而黏膜下、肌层及浆膜层的血流量增加。而且 ,PHG时胃黏膜损伤后其局部血流量不能增加 ,提示胃黏膜对有害物质的敏感性增加。1 2　胃黏膜屏障破坏　PHG时胃…     

Portal Vein Stenting for Portal Biliopathy with Jaundice

Portal biliopathy refers to obstruction of the bile duct by dilated peri- or para-ductal collateral channels following the main portal vein occlusion from various causes. Surgical shunt operation or endoscopic treatment has been reported. Herein, we report a case of portal biliopathy that was successfully treated by interventional portal vein recanalization.     

Portal imaging

Portal imaging is the acquisition of images with a radiotherapy beam. Imaging theory suggests that the quality of portal images could be much higher if the efficiency of the imaging media in detecting radiation could be improved. Introduction of new media (films and electronic portal imaging devices) has confirmed this by markedly increasing the quality of portal images. Images from these devices can then be used to verify a patient's treatment. Geometric verification requires the portal image to be registered with a reference image. Dosimetric verification requires the portal imager to be calibrated for dose. This review gives a brief overview of the current areas of interest in portal imaging: imaging theory; imaging media, film and electronic portal imaging devices; image registration; and dosimetry using these devices.     

Portal Vein Recanalization for Noncirrhotic Portal Vein Cavernous Transformation: Transjugular Intrahepatic Portosystemic Shunt Creation versus Portal Vein Stent Placement

PurposeTo compare the clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) creation versus portal vein stent placement (PVS) in patients with noncirrhotic cavernous transformation of the portal vein (CTPV).Materials and MethodsIn this retrospective study, clinical data from patients with noncirrhotic CTPV who underwent TIPS creation or PVS were compared. A total of 54 patients (mean age, 43.8 years ± 15.8; 31 men and 23 women) were included from January 2013 to January 2021; 29 patients underwent TIPS creation, and 25 patients underwent PVS. Stent occlusion, variceal rebleeding, survival, and postprocedural complications were compared between the 2 groups.ResultsThe mean follow-up time was 40.2 months ± 26.2 in the TIPS group and 35.3 months ± 21.1 in the PVS group. The stent occlusion rate in the PVS group (16%, 4 of 25) was significantly lower than that in the TIPS group (41.4%, 12 of 29) during the follow-up (P = .042). The cumulative variceal rebleeding rates in the TIPS group were significantly higher than those in the PVS group (28% vs 4%; P = .027). The procedural success rate was 69% in the TIPS group and 86% in the PVS group (P = .156). There was a higher number of severe adverse events after TIPS than after PVS (0% vs 24%; P = .012).ConclusionsPortal vein recanalization with PVS may be a preferable alternative to TIPS creation in the treatment of noncirrhotic CTPV because of higher stent patency rates, lower risk of variceal rebleeding, and fewer adverse events.     

Portal vein aneurysm.

While there have been a few references to portal vein aneurysm in the world literature, this is the first report in United States radiologic literature. During a routine evaluation for fever in one patient, an ultrasound examination suggested this unusual entity at the junction of the splenic and superior mesenteric vein. It was later confirmed by angiography. Two other patients were being investigated angiographically for gastrointestinal bleeding when portal vein aneurysms were discovered. In contrast to the central location of the first patient's aneurysm, the latter two were more distal in the portal tree. The literature is reviewed and different etiologic hypothesis discussed.     

特发性门静脉高压并门静脉系血管壁钙化1例报告

患者男,38岁。左肋缘下可扪及索条状硬物20余年,并逐渐长大。近半年来腹胀感逐渐加重、食欲减退。体检:轻2.28×1012/L,Hb 62 g/L;PLT 59×109/L。肝炎5项指标均阴性,肝功能正常。3个月前体力劳动后诱发上消化道出血1次,住院经保守治疗后症状缓解。CT表现:肝脏形态不规整,左叶较大,右叶较小,胆囊后移,肝实质未见异常密度影。胆管系统无扩张,门静脉主干及肝内分支、脾静脉明显增粗(门静脉直径约32.1 mm、脾静脉直径约28 mm),管壁可见多发斑点状、弧线状钙化(图1)。肠系膜上静脉未见明显增粗,但管壁亦见高密度钙化影。脾脏明显增大,最大面…