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食管静脉曲张出血的治疗近年有较大进展,内镜下硬化剂注射已成为主要方法。仅10%～15%的病人因疗效不佳还需急诊门腔静脉分流术,但手术创伤大,并不增加病人存活率。肝移植手术近年日益普及,但急性出血病人因病情重和供体肝短缺,不可能立即作肝移植手术。经颈静脉插管介入,经肝穿刺门-肝静脉分流术于1990年首例成功,开拓了治疗的又一新途径。病人和方法13例食管静脉曲张并顽固出血的病人采用这种疗法,效果良好。13例中男7例、女6例,平均年龄46岁。9例为门脉性肝硬化,4例坏死后性肝硬化;病情重达Child分级C级者占11例。操作方法:消毒右颈内静脉,铺巾,穿刺静脉,在荧光屏下送进带钢丝的导管,经过上腔静脉、右心房、下腔静脉,到达肝静脉右枝或中技。将导管取出,沿钢丝插入直径3mm套管,取出钢丝,换入穿刺针,在CT或超
Esophageal variceal bleeding treatment in recent years have made great progress, endoscopic sclerotherapy has become the main method of injection. Only 10% to 15% of patients due to poor efficacy of emergency portal venous bypass, but the surgical trauma, does not increase the patient survival rate. Liver transplantation has become increasingly popular in recent years, but patients with acute hemorrhage may not immediately undergo liver transplantation because of their serious illness and donor liver shortages. Intervening through the jugular vein, the first successful liver-bypass shunt in 1990 opened up new avenues of treatment. Patients and Methods Thirteen patients with esophageal varices and stubborn hemorrhage using this therapy, the effect is good. 13 cases of male 7 cases, 6 females, average age 46 years old. 9 cases of portal cirrhosis, 4 cases of post-necrotic cirrhosis; grading of Child grading C-class accounted for 11 cases. Method of operation: disinfection of the right internal jugular vein, shop towel, puncture the vein, under the screen into the catheter with a wire, after the superior vena cava, right atrium, inferior vena cava, to reach the right hepatic vein branches or technology. The catheter removed, along the wire into the diameter of 3mm casing, remove the wire, into the puncture needle, CT or super