双源CT在经颈静脉门腔分流术后随访中的应用

目的 观察双源CT在经颈静脉肝内门-体分流术(TIPS)后随访中的应用价值。方法 对28例肝硬化门静脉高压合并上消化道出血或大量腹腔积液接受TIPS的患者,于术后1个月内、3个月内、6个月、12个月、18个月、24个月进行双源CT复查,采用MIP、VR等图像后处理技术,判断肝静脉及门静脉间支架位置通畅情况。结果 28例患者中,3例(10.71%)支架内血栓形成,MIP示支架处低密度灶,对比剂自狭窄处流过,VR示支架位置、角度满意,及时行球囊扩张溶栓治疗;1例(3.57%)支架冗长、成角,再次植入支架;24例(85.71%)TIPS术后未出现分流道狭窄或血栓,MIP成像显示支架通畅,内见对比剂通过,VR显示支架位置、角度满意。结论 双源CT血管成像技术具有安全、无创、准确的优点,且同时能对肝实质进行观察,可作为TIPS术后的首选随访手段。     

抗凝药物在预防TIPSS术后分流道狭窄治疗中的临床应用和选择

目的:研究抗凝药物在经颈静脉穿刺肝内门腔静脉分流术(transjugularintrahepaticportosystemicstentshunt,TIPSS)术后预防和治疗分流道异常中的临床应用。方法:通过回顾性分析在我院接受过TIPSS治疗患者术后服用抗凝药物阿司匹林、华法林治疗情况,对比随访期间出现分流道异常的发生几率。结果:TIPSS术后1周、3个月抗凝治疗对分流道有无异常影响不大;术后6个月抗凝治疗有效,但两种抗凝药物之间差异无显著性;术后12个月及以后阿司匹林抗凝作用疗效和非抗凝组之间差异无显著性,而服用华法林组仍然存在较高的分流道通畅率,具有统计学意义。结论:TIPSS术后合理应用抗凝药物可有效降低分流道狭窄和(或)闭塞,提高近期和中期临床疗效,但远期疗效仍需进一步研究。     

Expanded PTFE-covered stent-grafts in the treatment of transjugular intrahepatic portosystemic shunt (TIPS) stenoses and occlusions

Background We evaluated the efficacy of the VIATORR endoprosthesis for the management of transjugular intrahepatic portosystemic shunt (TIPS) dysfunction. Methods Twelve consecutive patients (10 men and two women, mean age 52.7 years) with recurrent TIPS dysfunction underwent TIPS revision with use of the VIATORR endoprosthesis. Nine patients were asymptomatic and three patients had developed recurrent variceal bleeding. All patients had previous shunt revisions (mean 2.1 revisions per patient) with angioplasty or bare stents. Follow-up included clinical assessment, Doppler ultrasound, and portal venography. Results TIPS revision was successful in all patients, without complications. The mean portosystemic pressure gradient decreased from 16.8 ± 2.7 mmHg to 6.5 ± 2.6 mmHg. Hemostasis was achieved in all three patients who had recurrent variceal bleeding at the time of the procedure. Mean follow-up was 21.9 ± 10.7 months. In two patients TIPS dysfunction occurred at 14 and 30 months after stent-graft placement, respectively. The primary patency rates were 100% after 12 months and 88.8% after 24 months. Two patients (16.6%) developed encephalopathy after stent graft placement. Conclusion TIPS revision using the VIATORR endoprosthesis appears to be an effective and durable method to control shunt dysfunction.     

探讨彩色多普勒超声在TIPSS术后随访中的作用

目的探讨彩色多普勒超声在监测经颈内静脉肝内门体静脉分流术后支架内并发症的作用.方法回顾分析46例行经颈内静脉肝内门体静脉分流术(transjugular intrahepatic portosystemic stent shunts,TIPSS)的肝硬化患者 ,共82例次超声检查,检查内容包括支架内有无血流及多普勒信号,支架内最高流速(Vmax ),门脉分支血流方向.结果彩色多普勒超声诊断支架狭窄的敏感性和特异性分别为82.6%(19/ 23)、93.2%(41/44),诊断闭塞的敏感性和特异性分别为100%(12/12)、95.7%(67/ 70).所有82例次超声检查均观察门脉分支的血流方向,支架通畅时45.5%(20/44)出现离肝血流,而在支架狭窄或闭塞时,10.5%(4/38)出现离肝血流.所有超声检查均与X- 线造影对照.结论彩色多普勒超声在判断支架功能时具有较高的敏感性和特异性,可作为TIPSS术后随访的首选方法.     

彩色多普勒超声和能量多普勒超声对经颈静脉肝门-体静脉支架分流术后的评价

目的探讨彩色多普勒和能量多普勒超声在经颈静脉肝内门-体静脉支架分流术(TIPSS)后内支架血流动力学情况及其在随访中的价值。方法24例肝硬化门脉高压患者行TIPSS,术后应用彩色多普勒和能量多普勒检查72例次,测量支架的血流速度。结果随访3个月~2年,彩色多普勒和能量多普勒显示支架内的血流方向,频谱多普勒显示支架内以及门静脉和脾静脉的血流速度。从支架门静脉端到支架肝静脉端血流速度逐渐增加。1例患者多普勒血流显示支架内狭窄,为门静脉造影证实。与正常支架比较,狭窄支架的血流速度测值差异有显著性意义(P<0.05)。结论彩色多普勒和能量多普勒超声可以方便有效地检测TIPSS术后内支架的血流情况,是TIPSS术后定期复查和疗效判断的首选方法。     

股浅动脉硬化闭塞症应用Deep球囊扩张和球囊扩张联合支架植入疗效的比较

目的 探讨分别采用Deep球囊扩张和球囊扩张联合血管内支架植入两种方法治疗股浅动脉狭窄闭塞症的疗效。方法 38例患者按就诊顺序随机分为治疗组(19例)和对照组(19例)。治疗组患者均接受Deep球囊扩张治疗;对照组均接受球囊扩张后植入血管内支架,应用统计学方法比较两组疗效。结果 介入治疗后两组即时血管通畅率均为100％;介入治疗后30天,治疗组血管通畅率为100%,对照组为95%;介入治疗后1年,治疗组血管通畅率为85％,对照组74％。对治疗组与对照组病例的踝肱指数作两样本t检验,术后即时:P=0.504;术后30天:P=0.024;术后1年:P=0.002。结论 使用Deep球囊扩张治疗股浅动脉狭窄闭塞症30天及1年的血管通畅率高于球囊扩张联合支架植入治疗,其主要机制是Deep球囊具有顺应性好,低剖面扩张时不易造成对血管的损伤。     

Application of transmesenteric vein extrahepatic portosystemic shunt in treatment of symptomatic portal hypertension with cavernous transformation of portal vein

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 2020and 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 portosystem...     

A new choice of stent for transjugular intrahepatic portosystemic shunt creation: Viabahn ePTFE covered stent/bare metal stent combination

ObjectivesTo compare the clinical outcomes in terms of structure and function between the insertion of a transjugular intrahepatic portosystemic shunt (TIPS) created with the Viabahn ePTFE covered stent/bare metal stent (BMS) combination and the Fluency ePTFE covered stent/BMS combination.MethodsA total of 101 consecutive patients who received a TIPS from February 2016 to August 2018 in our center were retrospectively analyzed. Sixty-four subjects were enrolled in the Viabahn group and 37 were enrolled in the Fluency group. The geometry characteristics of the TIPS were calculated, and the associated occurrence of shunt dysfunction, survival, overt hepatic encephalopathy, and variceal rebleeding were evaluated.ResultsThe technical success rate was 100%. After the insertion of the TIPS, the rate of shunt dysfunction during the first 3 months was significantly different between the Viabahn and Fluency groups (1.6% and 13.5%, respectively; p ​= ​0.024). Multivariate analysis indicated that the angle of portal venous inflow (α) was the only independent risk factor for shunt dysfunction (hazard ratio ​= ​1.060, 95% confidence interval ​= ​1.009–1.112, p ​= ​0.020). In addition, 3 months after the TIPS insertion, the α angle distinctly increased from 20.9° ​± ​14.3°–26.9° ​± ​20.1° (p ​= ​0.005) in the Fluency group but did not change significantly in the Viabahn group (from 21.9° ​± ​15.1°–22.9° ​± ​17.6°, p ​= ​0.798).ConclusionsShunt dysfunction was related to the α angle owing to the slight effect on the α angle after the implantation of the TIPS. The Viabahn ePTFE covered stent/BMS combination was more stable in structure and promised higher short-term stent patency compared with the Fluency ePTFE covered stent/BMS combination.     

超声引导下经颈静脉肝内门体分流术

本文报道经颈静脉肝内门体分流术治疗２６例门脉高压症，术前由彩色多普勒超声检查．术中Ｂ超引导穿刺，并获成功，使门脉与肝静脉平均压力梯度从３．３３ｋＰａ下降到０．８２ｋＰａ。此手术安全、简便、定位准确，且穿刺成功率高。     

Feasibility of electromagnetically guided transjugular intrahepatic portosystemic shunt procedure

Objectives: To develop an electromagnetic navigation technology for transjugular intrahepatic portosystemic shunt (TIPS) creation and translate it from phantom to an in-vivo large animal setting.

Material and methods: A custom-designed device for TIPS creation consisting of a stylet within a 5 French catheter as well as a software prototype were developed that allow real-time tip tracking of both stylet and catheter using an electromagnetic tracking system. Feasibility of navigated TIPSS creation was tested in a phantom by two interventional radiologists (A/B) followed by in-vivo testing evaluation in eight domestic pigs. Procedure duration and number of attempts needed for puncture of the portal vein were recorded.

Results: In the phantom setting, intervention time to gain access to the portal vein (PV) was 144?±?67?s (A) and 122?±?51?s (B), respectively. In the in-vivo trials, TIPS could be successfully completed in five out of eight animals. Mean time for the complete TIPS was 245?±?205?minutes with a notable learning curve towards the last animal.

Conclusions: TIPS creation with the use of electromagnetic tracking technology proved to be feasible in-vitro as well as in-vivo. The system may be useful to facilitate challenging TIPSS procedures.     

TIPSS术后肾脏血流动力学改变的超声评价

目的　探讨经颈静脉肝内门 -体静脉分流术 (TIPSS)术后肾脏血流动力学改变及超声评价的价值。方法　应用超声技术检测并分别比较肝硬化腹水患者 (含肝肾综合征 )和肝硬化无腹水患者 TIPSS术前及术后 1周的肾脏血流动力学改变 ,同时测定并分别比较两组患者相应时相点肾功能情况。结果　肝硬化腹水患者术后 1周肾脏多普勒能量图显示较术前各级动脉血流信号明显增多 ,部分患者皮质血流得以显示 ,肾血流量 (V)较术前明显增加 (P<0 .0 1) ,肾血流阻力指数 (RI)较术前明显减小 (P<0 .0 1) ,血清肌酐 (Cr)、血清尿素氮(BUN)也较术前减少 (P<0 .0 1)。而肝硬化无腹水患者肾脏血流动力学以及肾功能各项指标手术前后无明显改变。结论　 TIPSS手术可明显改善肝硬化腹水患者肾血流灌注和肾功能 ,并可成为治疗肝肾综合征 (HRS)的有效手段 ,而对于肝硬化无腹水患者的肾血流动力学及肾功能则无明显影响。超声检测可客观地评价这些变化     

Transcatheter recanalization of acutely occluded modified systemic to pulmonary artery shunts in infancy

Background There are few data on successful recanalization of acutely occluded modified aortopulmonary shunts in infants in whom the major component of pulmonary flow is shunt-dependent. Patients and methods Seven infants (age range 6 days to 7 months) with modified (polytetrafluoroethylene) aortopulmonary shunts (central shunt n = 6, modified Blalock-Taussig shunt n = 1), in whom acute shunt occlusion was documented following surgery (interval from shunt surgery 2–6 days) underwent emergency cardiac catheterization with a view to reopening the shunt. Anterograde right ventricle to pulmonary artery flow was present in three patient; two other had additional aortopulmonary collateral vessels, and intravenous prostaglandin E (PGE1) infusion was restarted in three infants to achieve or maintain ductal patency. All occluded shunts could be crossed with a 4F endhole catheter and various guidewire combinations. Balloon dilation was performed using a balloon with the same nominal diameter as the shunt (5 or 6 mm). Results All shunts were successfully recanalized. Two infants with recurrent cyanotic episodes underwent stent implantation in the right ventricular outflow tract (RVOT) during the same procedure. One infant required shunt revision 24 h following balloon angioplasty, during which a small clot was evacuated from the distal end of the shunt. An immediate improvement in oxygen saturation could be documented in all patients. In the remaining six infants, shunt patency was confirmed at follow-up, until further definitive repair. One infant died of non-cardiac causes, while awaiting definitive repair. Conclusions This small series demonstrates that acutely occluded shunts can be successfully recanalized, and that patency can be maintained until further definitive surgery in the majority of infants.     

Transjugular intrahepatic portosystemic shunt for repeated bleeding of hemorrhoids caused by severe portal hypertension with ectopic varices: A case report

BackgroundSevere portal hypertension is life-threatening and can bring adverse complications such as ascites, gastroesophageal varices, and edema. It can, even cause variceal hemorrhage, which may lead to a high risk of death. There is a rare incidence in bleeding of hemorrhoids caused by severe ectopic varices.Case presentationWe report the case of a female patient with a 20-year history of hepatitis B virus infection who presented with repeated bleeding of hemorrhoids caused by severe portal hypertension with ectopic varices that is connection between the superior mesenteric vein and rectal venous plexus. Laboratory results revealed a hemoglobin level of 74 g/L. Finally, the patient was successfully treated with transjugular intrahepatic portosystemic shunt (TIPSS) placement without variceal embolization after a multidisciplinary comprehensive opinion. In the two-month follow-up period, the patient had failed to develop hepatic encephalopathy or hematochezia, and computed tomography venography (CTV) indicated that the stent was unobstructed and ascites disappeared.ConclusionsTIPSS placement is effective for the case, and we hope this case can help improve clinicians’ awareness of hemorrhoidal bleeding with severe portal hypertension. Portal hypertension should also be considered during the diagnosis and treatment, as opposed to hemorrhoidal bleeding alone. Moreover, abdominal CTV is recommended as an effective imaging examination method to determine the stent status after operation.     

75例食管胃底静脉曲张破裂出血患者行颈静脉肝内门体静脉分流术的护理

目的总结肝硬化失代偿期食管胃底静脉曲张破裂出血患者行颈静脉肝内门体静脉分流术（transjugular intrahepatic portosystem stent-shunt,TIPSS）联合食管胃底静脉栓塞术（percutaneous transhepatic varices embolization,PTVE）的围术期护理要点。方法回顾性总结和分析75例肝硬化失代偿期食管胃底静脉曲张破裂出血患者行TIPSS联合PTVE的围术期护理经验。结果 75例患者均顺利完成手术,术后1例患者出现轻微肝性脑病,1例出现皮肤黏膜下出血,经治疗和护理均恢复良好。结论术前做好物品和患者准备,心理护理;术中娴熟的配合;术后加强病情观察和并发症的预防对提高手术安全性与成功率具有重要意义。     

彩色多普勒血流图对经颈内静脉肝内门体分流术疗效观察

应用彩色多普勒血流图观察６６例肝硬化门脉高压症行经颈内静脉肝内门体分流术（ｔｒａｎ－ｓｊｕｇｕｌａｒｉｎｔｒａｈｅｐａｔｉｃｐｏｒｔｏｓｙｓｔｅｍｉｃｓｔｅｎｔｓｈｕｎｔＴＩＰＳＳ）治疗的患者术后不同时期的门脉系血流动力学变化，检出支撑管栓塞２例，认为ＴＩＰＳＳ术对肝硬化门脉高压症的治疗有一定疗效。     

Transjugular intrahepatic portosystemic stent--shunt (TIPSS): long-term follow-up

We assessed the long-term efficacy of transjugular intrahepaticportasystemic stent-shunt (TIPSS) in 64 patients. Insertionwas successful in 56 patients (87.5%). The reasons for its usewere: variceal bleeding (49); ascites (6); portal hypertensivegastropathy (6); hypersplenism (2); and embolization of a spontaneousshunt (1). Fourteen patients were Childs A, 20 Childs B and28 Childs C cirrhotics. Two patients were non-cirrhotic; onewith amyloidosis and one with non-cirrhotic portal fibrosis.Patients were followed clinically and radiologically (Dopplerultrasonography and routine portography at 6 months). During33 patient-years of follow-up, 22 died, 12 during index admission(two were procedure-related) and nine were transplanted. Twentyfivepatients are alive, with a mean survival of 7.1 (SD 7) months.Variceal rebleeding occurred in 10 patients (22.7%), one ofwhom died, and was always associated with shunt insufficiency(shunt thrombosis 2, hepatic vein stenosis (HVS) 1, intimalhyperplasia (IH) 4, dislocated stent 1, inadequate stent 2).Clinical encephalopathy was induced in seven patients (17.1%) following TIPSS. All responded to medical therapy, but tworequired reduction in shunt size. Ascites improved after TIPSSin 36 patients (87.8%), but reaccumulated in seven (17.5%),associated with shunt dysfunction in five (SBP 2, IH 3, HVS2). Fatal sepsis occurred in two patients, and 14 other episodesof infection required antibiotics. TIPSS is a useful treatmentfor variceal bleeding, resistant ascites and portal hypertensivegastropathy. Shunt dysfunction and sepsis occur frequently,and regular surveillance is necessary.     

双重介入方法治疗肝硬化门脉高压症的超声观察

目的应用彩色超声多普勒（CDF）评价胃冠状静脉栓塞术（GCVE）与经颈静脉肝内门体静脉分流术（TIPSS）双重介入方法治疗肝硬化门脉高压症（PVH）的效果。方法从临床确诊为肝硬化PVH患者中筛选已行GCVE的12例患者行TIPSS治疗，应用CDF于手术前后分别检测门静脉（主干及分支）、肝静脉、脾静脉和分流道（术后支撑管）管径、血流及肝、脾和腹水等情况，将手术前后检测结果进行对比分析。结果术后患者的门静脉、脾静脉血流速度显著改善P〈0．01，管径明显缩小P〈0．05，门脉压力降低，急性出血停止，分流道通畅；2例分别于术后6个月和18个月发生狭窄；前者12个月发生阻塞，后者经再次分流道扩张后恢复。结论双重介入方法可明显提高肝硬化PVH的临床治疗效果。     

超声心动图在复杂紫绀型先天性心脏病双向Glenn分流术前、术后的临床应用

目的 探讨超声心动图在复杂紫绀型先天性心脏病双向Glenn分流术前、术后评价及随访中的应用价值.方法 对23例接受双向Glenn分流术的复杂紫绀型先天性心脏病患者,采用超声心动图分别测量术前、术后肺动脉主干及左、右分支的内径、左心室舒张末期内径、肺动脉峰值血流速度,并比较手术前后的变化情况,观察上腔静脉与肺动脉吻合处的血流速度和通畅程度.结果 1例患者于双向Glenn分流术后第2天死于低心输出量.对余22例患者术后进行超声随访6～36个月,术后血氧饱和度、肺动脉主干及左、右分支内径、左心室舒张末期内径及肺动脉峰值血流速度均较术前有不同程度改善(P＜0.05).结论 双向Glenn分流术可促进肺血管和左心室发育,提高血氧饱和度.超声心动图在复杂紫绀型先天性心脏病双向Glenn分流术的术前评估、术后近期监测及远期随访中具有一定临床应用价值.     

肝硬化门脉高压症介入放射学治疗的进展

肝硬化门脉高压食道胃静脉曲张破裂出血的介入放射学治疗的广泛应用已有２０多年。Ｌｕｎｄｅｒｇｕｉｓｔ和Ｖａｎｇ创用经皮经肝食道胃出血栓塞术（ＰＴＯ）和Ｒｉｃｈｔｅｒ等于１９８８年首先在临床使用经颈静脉肝内门体静脉内支架分流术（ＴＩ—ＰＳＳ）以来．取得了巨大成功。到现在ＴＩＰＳＳ已完成２０００例以上，并成为门脉高压食道周静脉曲张出血治疗的首选方法。ＴＩＰＳＳ是安全、侵袭小，适应症广且手术死亡率较外科为少。但作为Ｈ型５流术其固有的缺点有待克服。     

14例冠心病切割球囊腔内成形术的体会

目的:切割球囊冠状动脉腔内成形术的疗效评价.方法:对14例冠心痛患者17处病变行切割球囊扩张治疗,分析并短期随诊.结果:17处病变血管直接切割球囊治疗.由于全部病变为A型,成功率100%,7例支架内再狭窄全部扩张成功.17处病变血管切割球囊扩张后置入支架8例,无心包填塞,急性闭塞,急性心肌梗死及急诊冠脉旁路术发生,随访2～23个月,2例患者出现心绞痛,4例复查造影,1例发生再狭窄.结论:切割球囊冠脉腔内成行术安全、有效、短期疗效好.