经脾穿刺插管栓塞治疗门静脉高压上消化道出血

目的 评价经脾入路栓塞治疗门静脉高压上消化道出血的临床疗效及安全性.方法 20例乙型肝炎后肝硬化患者,均出现门静脉高压性食管胃底静脉曲张破裂出血.8例为右叶巨大肝癌;10例为肝癌合并门静脉癌栓,门静脉主干闭塞;2例为肝硬化并发门静脉主干血栓性闭塞.所有患者采取经脾穿刺,脾静脉插管至胃冠状静脉,用液态栓塞剂加弹簧圈栓塞曲张的食管胃底静脉.结果 18例患者手术成功,2例失败;共栓塞35支胃冠状静脉,栓塞成功患者均获有效止血,未出现并发症.结论 经脾穿刺插管栓塞治疗门静脉高压上消化道出血的方法安全有效,适合于患有巨大肝癌及(或)门静脉主干闭塞等无法采用经皮经肝入路或TIPS栓塞食管胃底静脉曲张的患者.     

经皮脾穿刺CO2门静脉造影与动脉法间接门静脉造影的对照研究

目的 对经皮脾穿刺CO2门静脉造影与动脉法间接门静脉造影进行对照研究，评价其造影效果及临床应用价值。方法 21例患者（男16例，女5例），原发性肝癌15例，转移性肝癌6例。分别同时行肠系膜上动脉间接门静脉造影和经皮脾穿刺CO2门静脉造影，对造影结果进行统计学分析，并对经皮脾穿刺CO2门静脉造影的安全性进行评估。结果 21例经皮脾穿刺CO2门静脉造影中20例造影成功，图像质量明显优于动脉间接法门静脉造影（t=6．815，P〈0．01）。木中有10例患者（10／21）CO2造影术中有一过性轻度腹部不适，1例术后脾脏出血。结论 经皮细针穿刺脾脏CO2造影可清晰显示门静脉结构，图像质量优于动脉法间接门静脉造影，造影方法简便、创伤小、经济；熟练的操作可以提高其安全性。     

直接法CO2门静脉造影术对肝脏肿瘤的诊断价值

目的探讨经皮脾穿刺门静脉CO2鄄DSA造影效果及其对肝脏肿瘤侵犯门静脉的评估价值。方法21例患者,原发性肝癌15例,转移性肝癌6例。以26G超细针在B超引导或透视定位下经皮穿刺至脾内,行CO2鄄DSA。结果19例清晰显示门静脉4级以上分支,图像质量优,门静脉分流显示清晰。9例门静脉分支受压移位,2例门静脉主干阻塞,2例肝内门静脉左支主干阻塞,1例门静脉左支主干严重狭窄,3例胃底静脉曲张,1例失败。术中8例患者无任何不适,10例患者有轻度腹部不适,2例有恶心感,1例腹痛,B超示脾包膜下血肿。结论经皮细针穿刺脾实质CO2鄄DSA可以清晰地显示门静脉及分支结构,显示肿瘤对门静脉分支的压迫或门静脉内癌栓,手术简单、快捷、创伤小,熟练的操作可避免风险。     

门静脉支架结合经动脉化疗栓塞在肝癌伴门静脉癌栓中的应用价值

目的：探讨门静脉支架结合经动脉化疗栓塞术（TACE）治疗肝癌伴门静脉癌栓的临床效果。方法．27例肝癌伴门静脉癌栓均采用经皮肝穿门静脉途径植入门静脉支架,1周后行TACE。记录手术成功、狭窄开通、并发症和手术死亡发生情况,随访支架通畅期和患者生存期。结果：门静脉通路穿刺成功率100％（27／27）;门静脉支架置入成功率96．3％（26／27）;发生肝性脑病3例及肝衰竭4例。支架中位通畅期6个月（1。18个月）,治疗后3个月、6个月、12个月以上患者生存率分别为51．85％（14／27）、29．63％（8／27）、18．52％（5／27）。结论：对肝癌伴门静脉癌栓,采用支架开通门静脉主干及分支为非肿瘤所在肝叶的门静脉,结合TACE治疗,可取得较好的疗效。     

B超、X线导向经皮穿刺门脉治疗晚期肝癌

中晚期肝癌的双重供血,特别是门脉供血肿瘤细胞增殖最活跃的肿瘤周边部分的理论,被多数学者证实。故肝癌行肝动脉、门静脉双重化疗是一个值得研究的课题。目前单纯经门脉直接灌注的研究报告不多。我们对31例晚期肝癌病人经皮穿刺门静脉及经脐门静脉插管灌注化疗药物取得了较好的临床效果,报道如下。1　资料和方法1.1　临床资料:本组31例原发性肝癌均经病理细胞学证实。其中11例在B超引导下行经皮经肝门静脉穿刺;12例为电视下经皮穿刺;8例为经脐门静脉插管灌注。设17例仅接受同方案外周静脉治疗为对照组,与B超下穿刺组对照。电视下穿刺及经…     

原发性肝癌腹壁转移的介入治疗

目的探讨对原发性肝癌腹壁转移灶采用介入治疗的方法和疗效。方法对8例原发性肝癌腹壁转移患者行动脉插管灌注化疗、栓塞治疗,或经皮穿刺瘤内无水乙醇注射术。结果7例患者行动脉插管化疗栓塞术获得技术成功,术后5例患者腹壁转移灶内碘油沉积良好;2例患者部分瘤灶内碘油沉积不满意,行分次瘤体内无水乙醇注射术;1例患者动脉插管未能找到供血动脉,单纯采用经皮穿刺瘤体内无水乙醇注射。所有患者瘤灶处腹壁疼痛缓解或消失,3例腹壁体表肿块隆起者,肿块变小,变软。7例AFP升高患者,术后有不同程度下降。1例隆起肿块发生破溃、感染,其他患者未发生严重并发症。结论对原发性肝癌腹壁转移灶采用动脉插管灌注化疗、栓塞治疗,结合经皮穿刺瘤体内无水乙醇注射,对控制肿瘤生长、缓解疼痛,提高生存质量是可行方法之一。     

双介入法治疗门脉高压症的数字成像技术

目的：探讨双介入法治疗门脉高压症的数字成像技术。方法：本文20例肝硬化病人，在X线透视和B超联合导向下经皮穿刺门静脉，行门静脉造影和胃冠关静脉造影栓塞。同时经皮股动脉穿刺行腹腔动脉造影，再作脾动脉造影和部分脾脏栓塞。结果：20例手术全部成功，均进行了胃冠状静脉和脾栓塞，复查DSA示栓塞效果满意。结论：运用X线数字成像技术，采用双介入治疗门脉高压症是一种安全有效的治疗方法。     

合并肝癌的门脉高压患者TIPS治疗适应证及临床结果

目的 评价肝癌患者行经颈静脉肝内门腔静脉分流术（TIPS）的安全性和可行性。方法 886例肝硬化门脉高压静脉曲张破裂出血行TIPS术病例中，36例术前伴有肝癌（4．06％），ChildA 级9例，B级11例，C级16例。31例患者术前已行至少2次肝动脉化疗灌注栓塞（TACE），癌肿已被较好控制。5例患者为急诊TIPS。肝内肿块经由增强CT确认不在穿刺分流道33例，3例居常规穿刺分流道。前者采用经典TIPS方法，后者采用经腔静脉避绕法向门静脉分支穿刺。结果 36例合并肝癌的TIPS分流道建立均获成功。静脉曲张出血及腹水得到的有效地控制。27例肝癌患者用TACE及经皮无水乙醇病灶注射已有效控制，平均术后生存率4．5年。结论 肝硬化门脉高压静脉曲张破裂出血，同时伴原发性肝癌患者TIPS是一种安全有效的方法。     

多层螺旋CT肝脏兼容性血管造影在肝癌介入治疗中的应用价值

目的 探讨多层螺旋CT（MSCT）肝脏兼容性血管造影在肝癌介入治疗中的应用价值。方法 MSCT肝癌CT检查患者45例,于动脉期22s、门静脉期55s行肝脏双期增强扫描,采用MPVR、MIP、VR、SSD重建技术行肝动脉、门静脉兼容性血管成像。其中22例作了肝动脉DSA造影及介入治疗。结果 动脉期肝动脉血管造影（SCTA）显示肿瘤血管31例,肿瘤染色17例,动-门脉分流（APS）9例。门脉期门静脉造影（SCTP）检出肿瘤对门静脉的侵犯25例,门静脉癌栓16例。MSCT显示的肿瘤血管、肿瘤染色、供血动脉的来源分布、APS及门静脉癌栓与DSA图像基本一致。MPVR、VR有利于检出肝癌供血动脉、肿瘤血管、肿瘤染色、APS及门静脉癌栓。结论 MSCT肝脏兼容性SCTA、SCTP血管造影,可为临床及肝癌介入治疗方案的制定提供更多信息。     

经皮肝穿刺肝静脉造影在肝静脉型Budd-Chiari综合征介入治疗中的应用

目的：探讨经皮肝穿刺肝静脉造影（ＰＴＨＶ）在肝静脉型Ｂｕｄｄ－Ｃｈｉａｒｉ综合征（ＨＶＢＣＳ）介入治疗中的临床应用。材料与方法：Ｃ地１０例ＨＶＢＣＳ实施２ＰＴＨＶ，并采用经皮肝静脉－颈静脉轨迹或Ｒｕｐｓ－１００肝穿装置行肝静脉开通术（ＰＴＡ和ＥＭＳ置入），结果：１０例ＨＶＢＣＳ患者皆行ＰＴＨＶ，Ｂ超导向４例，Ｘ线监视６例。介入开通成功９例，失败１例，其中轨迹法开通肝静脉３例，Ｒｕｐｓ－１００装置开     

经皮脾穿刺门静脉插管技术及临床应用

目的 探讨经皮脾穿刺门静脉插管(PTSPC)技术的可行性.方法 30例门静脉高压症患者接受经PTSPC行食管胃底曲张静脉栓塞术,其中2例同时接受门静脉支架植入术.病例纳入标准:门静脉主干阻塞(癌栓或血栓)和肝硬化严重肝萎缩患者;排除标准:凝血酶原时间(PT)＞20 s的严重凝血功能不良患者.17例患者为原发性肝癌合并门静脉主干癌栓、13例为肝硬化合并严重肝萎缩和(或)小至中量腹水.30例患者术前均有食管胃底静脉曲张破裂出血病史;术前凝血功能正常(PT＜14 s)16例,轻度降低(PT 14～17 s)10例,中度降低(PT 18～20 s)4例;均接受上腹部CT增强检查,并依据CT结果确定脾静脉分支的穿刺位置、方向及深度.术后回顾性分析PTSPC要点、并发症及临床应用价值.结果 30例患者,28例成功应用PTSPC进行门静脉插管;2例插管未成功者均为脾静脉脾内分支细小.发生与PTSPC相关并发症6例(20.0%),均为不同程度血红蛋白浓度下降(15～50 g/L);其中4例需要输血治疗,包括1例腹腔大出血,在术后2 h出现血压严重下降,经输入4个单位红细胞和补充血容量后好转.PTSPC成功的28例均行食管胃底曲张静脉栓塞术,其中2例在栓塞曲张静脉的基础上放置门静脉覆膜支架.28例患者术后中位随访时间6个月(1～42个月),死亡16例,其中14例为肝癌患者在术后1～12个月死亡,2例肝硬化患者分别在术后14、23个月死于肝功能衰竭.随访期间,发生静脉曲张再出血4例,累积再出血率为14.3%.结论 PTSPC是可行的,为经导管门静脉腔内治疗提供了一条新路径,但穿刺部位出血应引起足够重视.     

Percutaneous transhepatic catheterization of the portal vein: A combined CT- and fluoroscopy-guided technique

Combined CT- and fluoroscopy-guided transhepatic portal vein catheterization was performed in 44 patients selected for pancreatic islet cell transplantation. The method allowed catheterization with a single puncture attempt in 39 patients. In four patients two attempts and in one patient four attempts were necessary. One minor hematoma of the liver capsule occurred that required no further treatment. Compared with other methods the average number of puncture attempts was reduced.     

Percutaneous Transsplenic Portal Vein Catheterization: Technical Procedures,Safety, and Clinical Applications

PurposeTo 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.Materials and MethodsFrom 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.ResultsPTSPC 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.ConclusionsPTSPC is a safe and effective access for endovascular PV interventions in patients without a transhepatic window.     

Percutaneous Angioplasty of Portal Vein Stenosis that Complicates Liver Transplantation: The Mid-Term Therapeutic Results

Objective

We wanted to valuate the mid-term therapeutic results of percutaneous transhepatic balloon angioplasty for portal vein stenosis after liver transplantation.

Materials and Methods

From May 1996 to Feb 2005, 420 patients underwent liver transplantation. Percutaneous transhepatic angioplasty of the portal vein was attempted in six patients. The patients presented with the clinical signs and symptoms of portal venous hypertension or they were identified by surveillance doppler ultrasonography. The preangioplasty and postangioplasty pressure gradients were recorded. The therapeutic results were monitored by the follow up of the clinical symptoms, the laboratory values, CT and ultrasonography.

Results

The overall technical success rate was 100%. The clinical success rate was 83% (5/6). A total of eight sessions of balloon angioplasty were performed in six patients. The mean pressure gradient decreased from 14.5 mmHg to 2.8 mmHg before and after treatment, respectively. The follow up periods ranged from three months to 64 months (mean period; 32 months). Portal venous patency was maintained in all six patients until the final follow up. Combined hepatic venous stenosis was seen in one patient who was treated with stent placement. One patient showed puncture tract bleeding, and this patient was treated with coil embolization of the right portal puncture tract via the left transhepatic portal venous approach.

Conclusion

Percutaneous transhepatic balloon angioplasty is an effective treatment for the portal vein stenosis that occurs after liver transplantation, and our results showed good mid-term patency with using this technique.     

Percutaneous transhepatic portography. I. Technique and application.

Percutaneous transhepatic portography with selective catheterization of the portal vein and its tributaries was performed on 120 patients, of whom 71% had cirrhosis of the liver. The technique was improved by ultrasonically guided puncture, and the procedure was successful in 96% of the examinations. Collateral veins were visualized in 81% and esophageal or gastric varices in 69% of the patients with portal hypertension. The procedure was performed with little risk and discomfort, and portograms of high quality were obtained. Other applications of percutaneous transhepatic catheterization of the portal vein system are discussed.     

经皮脾静脉途径联合TIPS治疗伴海绵样变性的门静脉血栓

目的 探讨经皮脾静脉途径联合TIPS治疗伴海绵样变性的门静脉血栓的可行性、安全性和疗效.方法 对3例门静脉血栓伴门脉海绵样变性患者行经皮脾穿脾静脉途径开通门静脉,联合TIPS重建门静脉分流道.随访22～40个月,观察治疗效果、支架通畅情况、肝功能变化和并发症.结果 3例均成功.其中1例支架经由显著扩张的海绵样变性的侧支放置,术后7个月内出现2次肝性脑病前期症状,药物治疗后症状消失.1例患者于术后6个月内出现持续性的胆红素增高,最高总胆红素为88.2μmoL/L,直接胆红素68.7 μmoL/L.予以保肝、降黄治疗后总胆红素维持在(44.4±11.6)μmol/L,直接胆红素(29.7±12.8)μmol/L.较术前无显著变化.第3例术后恢复良好.3例无术中并发症,术后随访22～40个月,支架血流通畅,未再发静脉曲张出血.结论 在有限的治疗伴有海绵样变性的门静脉血栓的方法选择中,经皮脾穿刺脾静脉途径开通门静脉,联合TIPS是安全可行和有效的,虽然技术要求上更困难和更具挑战性.     

Percutaneous Transsplenic Access to the Portal Vein for Management of Vascular Complication in Patients with Chronic Liver Disease

Purpose

To evaluate the safety and feasibility of percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver diseases.

Methods

Between Sept 2009 and April 2011, percutaneous transsplenic access to the portal vein was attempted in nine patients with chronic liver disease. Splenic vein puncture was performed under ultrasonographic guidance with a Chiba needle, followed by introduction of a 4 to 9F sheath. Four patients with hematemesis or hematochezia underwent variceal embolization. Another two patients underwent portosystemic shunt embolization in order to improve portal venous blood flow. Portal vein recanalization was attempted in three patients with a transplanted liver. The percutaneous transsplenic access site was closed using coils and glue.

Results

Percutaneous transsplenic splenic vein catheterization was performed successfully in all patients. Gastric or jejunal varix embolization with glue and lipiodol mixture was performed successfully in four patients. In two patients with a massive portosystemic shunt, embolization of the shunting vessel with a vascular plug, microcoils, glue, and lipiodol mixture was achieved successfully. Portal vein recanalization was attempted in three patients with a transplanted liver; however, only one patient was treated successfully. Complete closure of the percutaneous transsplenic tract was achieved using coils and glue without bleeding complication in all patients.

Conclusion

Percutaneous transsplenic access to the portal vein can be an alternative route for portography and further endovascular management in patients for whom conventional approaches are difficult or impossible.     

Percutaneous Access via the Recanalized Paraumbilical Vein for Varix Embolization in Seven Patients

Objective

To evaluate the feasibility of percutaneous access via the recanalized paraumbilical vein for varix embolization.

Materials and Methods

Between July 2008 and Jan 2014, percutaneous access via the recanalized paraumbilical vein for varix embolization was attempted in seven patients with variceal bleeding. Paraumbilical vein puncture was performed under ultrasonographic guidance, followed by introduction of a 5-Fr sheath. We retrospectively evaluated the technical feasibility, procedure-related complications, and clinical outcomes of each patient.

Results

Recanalized paraumbilical vein catheterization was performed successfully in all patients. Gastroesophageal varix embolization was performed in six patients, and umbilical varix embolization was performed in one patient. Embolic materials used are N-butyl cyanoacrylate (n = 6) and coil with N-butyl cyanoacrylate (n = 1). There were no procedure-related complications. One patient underwent repeated variceal embolization 6 hours after initial procedure via recanalized paraumbilical vein, due to rebleeding from gastric varix.

Conclusion

Percutaneous access via the paraumbilical vein for varix embolization is a simple alternative in patients with portal hypertension.     

肝移植术后门静脉狭窄内支架治疗的价值

目的 探讨内支架治疗技术在肝移植术后门静脉狭窄治疗中的应用价值.方法 回顾性分析肝移植术后发生门静脉狭窄的7例患者资料,所有患者均采用内支架置入治疗,对患者临床资料、影像随访资料、介入治疗的并发症和预后等情况进行总结.结果 7例均成功置入门静脉内支架,所有患者术后均无与门静脉治疗相关的并发症发生.患者随访3～34个月.除1例因同时合并肝动脉闭塞、缺血性胆道损伤于术后3个月死于多脏器功能衰竭,其余6例患者影像随访显示门静脉通畅.结论 肝移植术后门静脉狭窄的介入内支架治疗是一种安全、有效的治疗方法.     

Feasibility, safety, and efficacy of percutaneous transhepatic injection of beta-cell grafts

PURPOSE: To evaluate the safety, feasibility, and clinical efficacy of percutaneous transhepatic injection of beta-cell grafts in patients with type 1 diabetes mellitus. MATERIALS AND METHODS: Between December 2001 and November 2003, 15 patients with C-peptide-negative type 1 diabetes underwent 31 percutaneous injections for intraportal implantation of beta-cell grafts. Grafts consisted of cultured beta-cell preparations as previously described. In 13 cases, the transplant procedure was done under sedation, whereas in 18 cases, general anesthesia was given. In all procedures, percutaneous access to the right portal vein occurred under ultrasound (US) guidance with use of a microbore puncture needle. The subsequent catheterization of the main portal vein was performed under fluoroscopic and angiographic control with use of a microbore delivery catheter and guide wire. Clinical, biochemical, and radiologic evaluation was performed before and after the procedure. RESULTS: In all cases, it was possible to access the portal vein (median number of needle passes, 1; range, 1-6). The volume of cultured beta-cell grafts injected for each transplantation averaged 0.58 mL (range, 0.26-1.60 mL) and the mean recorded procedure time (from puncture to catheter withdrawal) was 19 minutes (range, 10-80 min). Three patients presented with transient abdominal pain immediately after the procedure; postprocedural duplex US of the liver revealed a patent portal vein and end branches in all cases and a minor perihepatic fluid collection in another three patients. From the end of week 1 to week 3, a mean 3.8-fold increase in liver aminotransferase levels was measured in all recipients after the first implantation session. A similar increase was seen in only one patient after a second transplantation session. At 6 months after transplantation, 13 of 15 patients (86%) had a functioning graft with plasma C-peptide levels greater than 0.5 ng/mL. CONCLUSIONS: The combined US, fluoroscopic, and angiographic monitoring of percutaneous transhepatic injection with use of a microbore delivery catheter is a safe and reproducible radiologic procedure for transplantation of beta-cell grafts in diabetic patients. Increased posttransplantation C-peptide levels, which demonstrate acceptable graft function, can be obtained.