Control of variceal bleeding by superior mesenteric artery vasopressin infusion.

Liver function and clotting tests were evaluated in 39 patients with variceal bleeding prior to superior mesenteric artery vasopressin infusion. In six patients with mild hepatic dysfunction (Child's class A), permanent control of hemorrhage was achieved in all six and all survived the hospitalization. In 21 patients with moderate dysfunction (Child's class B), permanent control of hemorrhage was achieved in 13 (62%) and temporary control for 24 hr or longer in the remaining eight (38%). Survival in class B was 67% (14 of 21). In only four of 12 patients with severe hepatic dysfunction (Child's class C) was control of hemorrhage achieved (33 percent). None of these patients survived. Therapeutic failure also was associated with clotting derangements and the initial bleeding rate. It is concluded that the effectiveness of vasopressin in variceal hemorrhage is a function of the underlying liver disease and derangements in clotting function.     

不同肝功能分级肝硬化患者的食管压力测定

为了解不同肝功能分级肝硬化患者食管蠕动功能和食管压力变化的特点，选择肝硬化患者（肝硬化组）94例，均经临床或病理确诊为肝硬化且有食管静脉曲张，肝功能Child分级；A组38例，有8例伴发腹水，B级37例，有20例伴发腹水；C级19例，有18例伴发腹水，另选择无肝硬化的正常对照（正常对照组）72例，均无消化系统疾病及胃肠道症状，无腹部手术，外伤史。检查前7天停用所有影响胃肠动力的药物。采用美国Sandhill公司Biolab食管动力检测系统及配套分析软件。结果显示，肝硬化肝功能A－C级各组食管下段括约肌静息压依次降低，松弛压力增大，松弛率变小；肝硬化组食管上段蠕动波起始点速度变慢，蠕动性收缩减少，异常收缩增加；肝硬化肝功能A－C级各组食管体部下段蠕动压力幅值依次降低，蠕动波起始点速度变慢，蠕动性收缩减少，异常收缩增加。以上结果表明，肝硬化患者肝功能损害越重，对食管正常动力影响越大，同时肝硬化患者食管静脉曲张与腹水形成亦有协同作用。     

TIPSS加断流术治疗门静脉高压症的疗效观察

目的　研究TIPSS加断流术治疗门静脉高压症的临床疗效。方法　对 6 0例门静脉高压症伴食管静脉曲张破裂出血患者采用TIPSS加断流术治疗。治疗时伴有中度腹水 41例 ,重度腹水 8例 ,按Child Pugh分级标准肝功能为A级 11例 ,B级 37例 ,C级 12例 ,上消化道钡餐检查示食管静脉中、重度静脉曲张。治疗分两步进行 ,首先行TIPSS治疗 ,2周后再行断流术。结果　TIPSS术后无近期分流道阻塞、再出血和死亡 ,食管静脉曲张显著减轻。 1～ 5年随访 ,肝内分流道阻塞率、出血复发率和病死率分别为 11.9%、3.5 %和 7.0 %。结论　TIPSS加断流术是一种疗效确切的治疗门脉高压症的方法。     

Risk and causes of gastroesophageal bleeding in patients with liver cirrhosis

BACKGROUND/AIM: Variceal bleeding is the most life-threating complication in liver cirrhosis. The aim of this study was to analyze the sources of gastroesophageal bleeding in patients with liver cirrhosis and to ascertain the risk factors of bleeding from esophageal varices. METHODS: This prospective study included 52 patients with liver cirrhosis and portal hypertension. Severity of liver dysfunction according to Child's classification, coagulation parameters, and endoscopic findings were analyzed. In patients with varices we analyzed the size, color, location of varices, and the presence of red signs. The varices were classified as small, medium and large. RESULTS: Esophageal varices were found in 76.9% of the patients. Isolated varices were present in 36.6%, and associated with other findings in 40.3%. Small varices were present in 10%, medium in 25% and large in 65% patients. Of them 55% had variceal bleeding. Variceal bleeding was present in 50% of the patients with medium and in 65.38% of the patients with large varices. There was no bleeding in the patients with small varices. Endoscopy revealed red signs before bleeding in 85% of the patients with large varices. There was a higher incidence of variceal bleeding in the Child's group B. There were no significant differences (p > 0.05) in the coagulation parameters in patients with and without variceal bleeding. Rebleeding was present in 86.36% of the patients. Most of them (52.63%) were rebleeding between 7 weeks and 12 months after the first episode of variceal bleeding. In the patients with the most severe hepatocellular dysfunction (Child's group C) the period between the first bleeding and rebleeding was the shortest (mean, 20.8 days). CONCLUSION: Our study revealed that esophageal varices are the most frequent sources of bleeding in the patients with liver cirrhosis. There is the association between the first bleeding and large varices and the red signs. Coagulation disorders and hepatic dysfunction were not related to the initial episode of variceal bleeding. The risk of early rebleeding was higher in the patients with severe hepatic dysfunction (Child's class C).     

经颈静脉肝内门体分流术治疗脾切除术后静脉曲张再出血

目的评价经颈静脉肝内门体分流术（TIPS）治疗脾切除术后静脉曲张再出血的疗效及随访结果。 方法回顾性分析中山大学附属第三医院2010年12月至2016年12月间，因脾切除术后静脉曲张再出血而接受了TIPS治疗的患者33例，观察手术成功率、并发症及临床随访结果。 结果33例患者TIPS手术成功31例（93.9%），失败2例。成功的患者其门体压力梯度（PPG）从分流前平均23.5±5.9 mmHg下降至分流后平均12.1±3.3 mmHg（P<0.05）。除1例患者因感染性休克于围手术期死亡外，对手术成功的30例进行了随访（中位随访时间62.5个月）。10例发生分流道失功，其中4例再发消化道出血伴1例死亡、1例再发大量腹水、1例并发急性肠系膜静脉血栓、肠梗阻。10例出现显性肝性脑病，其中4例轻度发作经药物治疗后好转、1例反复发生3期肝性脑病行分流道限流术、5例术后死于肝功能衰竭。随访期间除上述6例死亡以外，另有2例因肺部疾病及1例因肝细胞癌死亡。余患者随访期间分流道通畅且未再发生静脉曲张破裂出血。术后第6个月随访结果显示，30例患者的平均血清白蛋白、血清总胆红素较术前改善（P<0.05）。 结论TIPS是治疗脾切除术后静脉曲张再出血安全且有效的方式。     

Transjugular Intrahepatic Portosystemic Shunt Placement in Patients with Cirrhosis and Concomitant Portal Vein Thrombosis

Purpose To determine the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with liver cirrhosis complicated by thrombosed portal vein. Methods This study reviewed 15 cases of TIPS creation in 15 cirrhotic patients with portal vein thrombosis at our institution over an 8-year period. There were 2 women and 13 men with a mean age of 53 years. Indications were refractory ascites, variceal hemorrhage, and refractory pleural effusion. Clinical follow-up was performed in all patients. Results The technical success rate was 75% (3/4) in patients with chronic portal vein thrombosis associated with cavernomatous transformation and 91% (10/11) in patients with acute thrombosis or partial thrombosis, giving an overall success rate of 87%. Complications included postprocedural encephalopathy and localized hematoma at the access site. In patients with successful shunt placement, the total follow-up time was 223 months. The 30-day mortality rate was 13%. Two patients underwent liver transplantation at 35 days and 7 months, respectively, after TIPS insertion. One patient had an occluded shunt at 4 months with an unsuccessful revision. The remaining patients had functioning shunts at follow-up. Conclusion TIPS creation in thrombosed portal vein is possible and might be a treatment option in certain patients.     

Transjugular intrahepatic portosystemic shunts in the treatment of refractory ascites: results in 48 consecutive patients

PURPOSE: To assess the efficacy, morbidity, and mortality involved in the creation of transjugular intrahepatic portosystemic shunts (TIPS) in the treatment of patients with refractory ascites in Child-Pugh classes B and C. MATERIALS AND METHODS: Forty-eight consecutive patients with refractory ascites were treated with TIPS creation in a tertiary care institution. They were followed for a median of 337 days (range, 3-1376 d). RESULTS: TIPS significantly decreased the portohepatic pressure gradient (20.7 +/- 5.9 mm Hg vs. 6.8 +/- 4.1 mm Hg; P < .0001). Seventy-three percent of patients had complete or partial response. One year after TIPS creation, survival was 73% in Child class B patients and 56% in Child class C patients. Thirteen patients experienced procedural complications (portal vein thrombosis, peritoneal bleeding, acute renal failure, pneumothorax, hemoptysis, spontaneous bacterial peritonitis, and heart failure) and TIPS creation was considered the cause of death in five patients (10.4%). Primary patency was 65% at 3 months and 23% at 1 year, but shunt obstruction was accessible for a second intervention. Ten patients (21%) had de novo encephalopathy after TIPS creation. CONCLUSIONS: This series suggests that TIPS is an effective treatment for refractory ascites; however, it is a challenging procedure and serious complications--usually renal and heart failure--can be seen. A careful selection of patients is mandatory.     

Transjugular intrahepatic portosystemic shunt in patients who have undergone liver transplantation.

PURPOSE: Transjugular intrahepatic portosystemic shunt (TIPS) placement is an accepted treatment for refractory variceal bleeding and/or ascites in end-stage liver disease and is an effective bridge to liver transplantation. The authors present their experience with TIPS in patients with a liver transplant, who subsequently developed portal hypertension. MATERIALS AND METHODS: Thirteen TIPS were placed in 12 adult patients from 6 months to 13 years after liver transplantation for variceal bleeding that failed endoscopic treatment (n = 6) and intractable ascites (n = 6). All patients were followed to either time of retransplantation or death. RESULTS: No technical difficulties were encountered in TIPS placement in any of the patients. Four of six patients treated for bleeding stopped bleeding and did not experience re-bleeding, two had functional TIPS at 3 and 36 months and two underwent retransplantation at 3 and 7 months. Two patients had recurrent bleeding within 1 week and required reintervention. In the ascites group, one is 32 months since TIPS placement with control of his ascites, two patients underwent retransplantation at 2 and 6 weeks with interval improvement in ascites. Two patients died within a week of TIPS of fulminant hepatic failure. The last patient died 1 month after TIPS subsequent to a splenectomy. CONCLUSION: In conclusion, the placement of a TIPS in a transplanted liver, in general, requires no special technical considerations compared to placement in native livers. Although this series is small, the authors believe that TIPS should be considered a treatment option in liver transplant recipients who present with refractory variceal bleeding. TIPS may have a role in the management of intractable ascites.     

经颈静脉肝内门体分流术治疗顽固性腹水

目的　探讨经颈静脉肝内门体分流术 (TIPS)治疗肝硬化顽固性腹水的效果及其影响因素分析。方法　 2 1例患者TIPS术后随访 5 0～ 132 3d(中位时间 337d) ,观察腹水 (腹围 )、临床血清学指标、支架通畅性、随访时间、生存率等。结果　在 1年的各个随访间期内 ,患者的腹水与术前比较均有明显改善 (P <0 .0 5 ) ,术后 3～ 6个月的完全有效率为 81% ,9～ 12个月的完全有效率为 91% ,单因素Logistic回归分析结果为肝硬化肝功能ChildC级与术后 3个月腹水疗效相关 (P <0 .0 5 ) ;TIPS术后血清钠 (Na )、肌酐 (Cr)与术前基线相比较 ,差异有显著性 (P <0 .0 5 )。患者 3、6个月病死率分别为14 %、2 0 % ,1年生存率为 72 % ;单因素COX回归分析显示年龄、肝功能Child分级、血清白蛋白、肝性脑病、血清总胆红素与术后预后相关 ;多因素COX回归仅显示肝性脑病、Child分级与预后相关。结论　TIPS是治疗顽固性腹水的有效方法 ;术前自身的肝功能情况决定腹水的疗效 ,而TIPS对于肝功能相对较好伴有肾功能衰竭的患者仍有效。     

Prospective Evaluation of Patients with Early-/Intermediate-stage Hepatocellular Carcinoma with Disease Progression Following Arterial Locoregional Therapy: Candidacy for Systemic Treatment or Clinical Trials

PurposeDuring the course of cancer treatment, patients whose disease progresses despite therapy are offered alternative options. Similarly, patients with hepatocellular carcinoma (HCC) whose disease progresses following arterial locoregional therapies (LRTs) cross over to undergo systemic therapies or participate in clinical trials. Per current guidelines, patients must meet inclusion criteria (most importantly Child–Pugh class A status) to qualify for systemic options. The present study analyzed the candidacy for systemic agents or clinical trials of patients whose disease progresses despite LRTs.Materials and MethodsA total of 245 patients with HCC were treated with LRTs (chemoembolization, n = 123; yttrium-90 [⁹⁰Y] radioembolization, n = 122) as part of a previously published comparative effectiveness study; 96 patients exhibiting disease progression were followed prospectively. Modes of progression (cancer stage, Child–Pugh class) were analyzed to determine candidacy for systemic therapy or clinical trials, as well as assess ultimate treatment(s) received.ResultsAmong the 96 patients with disease progression, 52% and 48% had Child–Pugh class A and class B/C disease, respectively, thereby substantially limiting the latter group’s eligibility for systemic therapy and/or clinical trials. Of those whose disease progressed who had advanced-stage HCC, 63% had Child–Pugh class B/C disease. By size and necrosis criteria, the local disease progression rate was higher with chemoembolization than with ⁹⁰Y radioembolization (P = .006 and P = .016, respectively). Of the 96 patients with disease progression, only 13 (13%) ultimately received systemic agents or entered clinical trials.ConclusionsMost patients with advanced HCC that progresses following LRTs were not candidates for clinical trials or systemic agents. There is a need for future research efforts directed at treatment options or novel trial designs that will permit inclusion of patients with progressive liver disease and suboptimal liver function.     

Emergent treatment of variceal bleeding in two infants

Two infants with portal hypertension were treated on an emergency basis for life-threatening uncontrollable variceal bleeding. One 9-month-old girl had portal vein thrombosis, and the other 28-months-old girl had liver cirrhosis secondary to biliary atresia. Following percutaneous transhepatic embolization of the varices, successful bleeding control was achieved in both patients.     

Quantitative evaluation of liver cirrhosis using T1 relaxation time with 3 tesla MRI before and after oxygen inhalation

Purpose:

To quantify liver T1 relaxation times before and after oxygen inhalation in patients with and without liver cirrhosis using a 3 Tesla (T) MRI.

Materials and Methods:

Institutional Review Board approval and written informed consent were obtained. Ninety‐two noncirrhotic patients and 87 patients with hepatitis B viral liver cirrhosis (72 Child‐Pugh class A and 15 Child‐Pugh class B or C) underwent MRI with a 3.0T system before and after the supply of 100% oxygen at a rate of 15 L/min by means of a nonrebreather ventilation mask for 3 min. T1 maps were acquired using three‐dimensional spoiled gradient echo sequences with two different flip angles (2° and 14°) and a fixed TR/TE (2.54 ms/0.95 ms). Liver T1 values were obtained using a T1 processing tool (MapIT software). The mean baseline T1 values of three groups (control, Child‐Pugh class A, and Child‐Pugh class B/C) were compared using an analysis of variance test. Liver T1 value before and after oxygenation was compared using a paired t‐test for each group.

Results:

The baseline liver T1 value was significantly higher in the control group (941 ± 136 ms) than in Child‐Pugh A (858 ± 143 ms) and Child‐Pugh B/C (783 ± 164 ms) group (P < 0.001 and P < 0.0001). The reduction in the liver T1 value after oxygen inhalation was significant in the control group (P = 0.012) but not significant in Child‐Pugh class A (P = 0.079) and Child‐Pugh class B/C (P = 0.752).

Conclusion:

The baseline liver T1 relaxation time was significantly different between the patients with and without liver cirrhosis. The shortening effect of oxygen on the liver T1 value was significant in the control group but not in the cirrhotic patients. J. Magn. Reson. Imaging 2012;36:405–410. © 2012 Wiley Periodicals, Inc.     

TIPS versus transcatheter sclerotherapy for gastric varices

OBJECTIVE: The purpose of our study was to compare the efficacy and long-term results of transjugular intrahepatic portosystemic shunt (TIPS) with those of transcatheter sclerotherapy for the treatment of gastric varices. MATERIALS AND METHODS: A total of 139 cirrhotic patients with gastric varices underwent endovascular treatment. Of the 139 patients, 104 without hepatocellular carcinoma were enrolled; 27 patients were treated with TIPS, and 77 patients with transcatheter sclerotherapy. Bleeding of gastric varices and survival rates were compared between the TIPS and transcatheter sclerotherapy groups. Multivariate analysis was used to identify the prognostic factors for gastric variceal bleeding and survival. Changes in liver function were evaluated in each group. RESULTS: The cumulative gastric variceal bleeding rate at 1 year was 20% in the TIPS group and 2% in the transcatheter sclerotherapy group (p < 0.01). The prognostic factor associated with gastric variceal bleeding was the treatment method. The cumulative survival rates at 1, 3, and 5 years were, respectively, 81%, 64%, and 40% in the TIPS group and 96%, 83%, and 76% in the transcatheter sclerotherapy group (p < 0.01). The prognostic factors for survival were the treatment method and the Child-Pugh classification of liver disease. For patients categorized in Child-Pugh class A, the survival rate was higher in the transcatheter sclerotherapy group than in the TIPS group (p < 0.01). For patients in Child-Pugh classes B and C, no significant difference was seen between the two groups. Liver function tended to improve in the transcatheter sclerotherapy group. CONCLUSION: Transcatheter sclerotherapy may provide better control of gastric variceal bleeding than TIPS. Transcatheter sclerotherapy may contribute to a higher survival rate than TIPS in patients with Child-Pugh class A disease.     

肝硬化患者行腹腔镜胆囊切除术探讨

目的探讨腹腔镜胆囊切除术（LC）在肝硬化患者合并胆囊疾病中的可行性与疗效。方法回顾分析32例肝硬化合并胆囊疾病实施腹膛镜胆囊切除术的临床资料。结果32例中顺利施行腹腔镜胆囊切除术30例，2例因出血而中转开腹。术后出现腹水3例，胆漏1例，经引流、保肝等治疗后痊愈。无腹腔感染及肝功能衰竭等严重并发症。结论肝功能ChildA、B级的肝硬化患者合并胆囊疾病行LC手术是可行的。加强围手术期处理是保证手术成功的关键。     

Transjugular Intrahepatic Portosystemic Shunt Creation for the Prevention of Gastric Variceal Rebleeding in Patients with Hepatocellular Carcinoma: A Multicenter Retrospective Study

PurposeTo evaluate the effectiveness and safety of transjugular intrahepatic portosystemic shunt (TIPS) creation for the prevention of gastric variceal rebleeding in patients with hepatocellular carcinoma (HCC).Materials and MethodsThis multicenter retrospective study included 126 cirrhotic patients (mean age, 54.1 ± 10.2 years; 110 men) with HCC who underwent TIPS creation for the prevention of gastric variceal rebleeding. Of these, 110 (87.3%) patients had gastroesophageal varices and 16 (12.7%) patients had isolated gastric varices. Thirty-five (27.8%) patients had portal vein tumor thrombus.ResultsTIPS creation was technically successful in 124 (98.4%) patients. Rebleeding occurred in 26 (20.6%) patients during the follow-up period. The 6-week and 1-year actuarial probabilities of patients remaining free of rebleeding were 98.3% ± 1.2% and 81.2% ± 3.9%, respectively. Forty-nine (38.8%) patients died during the follow-up period. The 6-week and 1-year actuarial probabilities of survival were 98.4 ± 1.1% and 65.6 ± 4.4%, respectively. Two (1.6%) patients had major procedure-related complications, including acute liver failure (n = 1) and intra-abdominal bleeding (n = 1). Thirty-three (26.2%) patients had at least 1 episode of overt hepatic encephalopathy during the follow-up period. Shunt dysfunction occurred in 15 (11.9%) patients after a median follow-up time of 11.4 months (range, 1.4–41.3 months). Lung metastasis occurred in 3 (2.4%) patients, 3.9–32.9 months after TIPS creation.ConclusionsTIPS creation may be effective and safe for the prevention of gastric variceal rebleeding in patients with HCC.     

Transjugular Intrahepatic Portosystemic Shunt (TIPS): Current Status and Future Possibilities

Since the insertion of the first TIPS in 1989 much has been learned about this therapeutic procedure. It has an established role for the treatment of some complications of portal hypertension: prevention of recurrent variceal bleeding and rescue of patients with acute uncontrollable variceal bleeding. In addition TIPS is useful for Budd-Chiari syndrome, refractory ascites and hepatorenal syndrome, although its specific role in these indications remains to be definitively established. However, the decrease in sinusoidal blood flow induced by TIPS can lead to the patient developing hepatic encephalopathy and liver failure in some cases. Therefore, TIPS should be used with caution in patients with very poor liver function. From a technical point of view, successful placement of TIPS is achieved in more than 98% of cases by experienced groups. At present, evaluation of TIPS dysfunction based on morphology probably leads to an overdiagnosis of this complication since most of these cases are not associated with clinical manifestations (recurrent bleeding or refractory ascites). The major disadvantage of TIPS remains its poor long-term patency requiring a mandatory surveillance program. The indicator for shunt function/malfunction should be the portosystemic pressure gradient, which is best assessed by intravascular measurements. Shunt obstructions may be prevented or reduced by the use of stent-grafts in the future.     

TIPSS技术在门脉癌栓性门脉高压中的应用

目的 探讨TIPSS技术在治疗门静脉癌栓合并门脉高压中的技术特点及禁忌证。方法 16例门静脉癌栓合并门脉高压症患者，9例门静脉主干完全堵塞，7例门静脉主干及分支有不同程度栓塞；6例合并门脉海绵样变；1例单纯上消化道大出血；4例单纯顽固性腹水；11例上消化道大出血合并顽固性腹水。结果 16例中11例患者成功行TIPSS治疗，技术成功率约68.8%，门脉压力从术前4.9kPa降至2.4kPa，平均降低2.5kPa，腹水减少或消失，症状缓解。平均生存136d。5例失败。结论 TIPSS是治疗门脉癌栓引起的上消化道大出血和顽固性腹水的有效方法，门脉海绵样变是该术的禁忌证。     

经皮经肝门腔静脉分流术血流动力学与支架构型关系的临床研究

目的介绍一种全新肝内分流预应力支架的结构和在经皮经肝肝内门腔静脉分流术（PTPS）中应用的临床结果。分析应用该支架建立的门腔静脉分流道与经典TIPS所用支架血流动力学之间的区别,探讨其潜在的临床意义。方法38例门静脉高压患者采用预应力支架行经皮经肝途径门腔静脉分流术（PTPS）。静脉曲张出血36例,难治性腹水1例及肝肺综合征1例;Child＇s B级27例、C级11例。经皮经肝穿刺进入门静脉右支,再经门静脉左支矢状部穿刺肝段下腔静脉,经皮经肝植入预应力支架于门静脉左支与肝段下腔静脉之间。结果38例采用预应力支架行PTPS均获成功,技术成功率100％,未出现术中与技术相关并发症,术后门腔压力梯度平均下降14cmH2O,平均随访493d,所有患者未发生再出血,难治性腹水得到有效地控制。初步开通率98．9%,明显高于经典直管形裸支架TIPS。结论采用预应力支架经皮经肝途径建立门腔静脉分流是安全可行的,其血流动力学结果提示：预应力支架形状及与相关血管壁间“吻合”严密,符合正常肝内门静脉血流动力学分布,既起到门静脉部分性降压作用,亦保障了门静脉右支血流的肝内灌注,对预防术后分流道再狭窄及降低肝性脑病发生率具有明显的临床意义。     

Portal and hepatic vein thrombosis in liver abscess: CT findings

OBJECTIVE: Our aim is to describe imaging findings of portal and hepatic vein thrombosis in pyogenic liver abscess on contrast-enhanced MDCT and to determine the incidence and evolving patterns on follow-up imaging. METHODS: Over a 5-year period, 67 patients with liver abscess underwent single-phase (n=30) or triphasic (n=37) contrast-enhanced CT. Images were reviewed for the presence of portal vein (PV) or hepatic vein (HV) thrombosis, regional parenchymal attenuation, and changes on follow-up CT. RESULTS: Venous thrombosis was seen in 28/67 patients (42%), involving PV in 16/67 (24%) and HV vein in 15/67 (22%); 3/67 (4%) had both PV and HV thrombosis. Thrombosis was seen as non-enhancing linear structures without expanding the lumen in all cases. Regional parenchymal attenuation during the portal-phase was hyperattenuating (10/16, 63%) or isoattenuating (6/16, 38%) in PV thrombosis, and mostly hypoattenuating (13/15, 87%) in HV thrombosis (P<.001). Of 27 patients with follow-up contrast-enhanced CT, venous thrombosis resolved in 10/27 (37%) within 6 months and persisted in 17/27 (63%) for 3-38 months, including 13 PV thrombosis and 4 HV thrombosis. Interval parenchymal atrophy was seen only in four all with persistent PV thrombosis. CONCLUSIONS: Both PV and HV thrombosis frequently occurs in liver abscess and is seen as non-enhancing linear structures without expanding the lumen on contrast-enhanced CT. Regional attenuation changes in hepatic vein thrombosis were often hypoattenuating whereas none with portal vein thrombosis showed hypoattenuation.     

经皮经肝肝内门体分流术的手术方法与临床应用

目的介绍经皮经肝肝内门体分流术（PTIPS）的手术方法及围术期情况。 方法2009年11月—2013年3月,76例门静脉高压患者接受经门静脉右支PTIPS,临床表现为消化道出血69例（其中23例合并不同程度腹腔积液）,单纯性顽固性腹腔积液7例。术前肝功能Child-Pugh A级23例,B级35例,C级18例。上腹部CT/MRI显示34例肝脏重度萎缩,肝裂明显增宽;25例伴门静脉血栓/癌栓形成合并门静脉海绵样变性。经皮成功穿刺门静脉右下分支后,沿同一穿刺道经门静脉"逆行"穿刺肝静脉或肝段下腔静脉,建立肝内门体分流道。 结果76例患者PTIPS成功率100%。门静脉压差由术前（32.35±2.89）mmHg降至术后（18.42±1.32）mmHg（P<0.001）。2例患者发生腹腔出血,栓塞相应肝动脉后治愈。1例肝功能C级患者术后5天因肝衰竭死亡,余75例患者术后1个月内门脉高压症状消失。 结论PTIPS是传统经颈静脉肝内门体分流术（TIPS）的补充,是一种安全、有效的治疗方法,手术成功率高,大大拓展了介入性门体分流术的应用范围。