DSA在经颈静脉途径肝内门体分流术(TIPSS)中的应用

本文报告９例应用ＤＳＡ进行经颈静脉途径肝内门体分流术。使用ｐｈｉｌｉｐｓ公司生产的ＡＲＣ－Ａ型ＤＳＡ机器。患者年龄２４岁－６２岁，肝硬化病史３－１０年，内镜和上消化道钡餐证实为食管及胃底中重度静脉曲张。结果：７例成功，２例失败。建立分流术后门脉压从术前３．６５～４．１０ｋＰａ，降至２．３０～２．７０ｋＰａ，Ｄｏｐｐｅｒ超声波显示门脉主干血流从术前１１～２２ｃｍ／ｓｅｃ，增加至３４～６８ｃｍ／ｓｅｃ，静脉曲张消失或减轻，３例术前少量腹水，术后消失。初步结论，利用ＤＳＡ进行ＴＩＰＳ具有造影剂用量小，浓度低，节省胶片之优点；可变换部位多次投照，便于了解肝静脉主要分支的空间关系。ＴＩＰＳＳ创伤小，降低门脉压可靠，是治疗门脉高压症的优良方法。

Tranjugular Intrahepatic Portosystemic Stent Shunt(TIPSS) Using Digital Subtraction Angiograohy

This paper reported the clinical and procedural results of nine consective TIPSS using digital subtraction angiographic(DSA)instrument (Philips ARC-A).The patients were aged 24-62 years. All patients had the histories of liver cirrhosis with gastroesophageal varices which were confirmed by endoscopic and barium examination,The results showed that shunts were completed in seven,failed in two Portal vein pressure was reduced from 3.65-4.10kPa before shunting to 2.30-2. 70kPa after shunting.Doppler us revealed that the maximum blood flow velocity in the main portal vein increased from 11-22cm/s to 34-68cm/s Mild ascites in 3 cases resolved,the varices disappeared or abated obviously in all successful cases.The initial results suggest that TIPSS is a less invasive and effective method of portal decompression,and that the advantages of using DSA for TIPSS procedure are minimizing the amount and concentration of contrast media needed,reducing film use,and thd facilities for evaluating the hepatic vessels with mutiple direction projection.