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目的探索X射线引导下经颈内静脉路径从下腔静脉直接穿刺肝外门静脉主干,建立肝外门腔分流道的可行性及安全性。方法 6头健康家猪,超声引导下经皮经肝路径,置入5F猪尾导管于门静脉主干作靶导管。超声引导下经颈内静脉路径,置入RUPS-100穿刺系统于下腔静脉。X射线引导下,从下腔静脉穿刺靶导管,以Fluency覆膜支架建立肝外门腔分流道,行分流道造影。术后3 d及2周,行全腹部增强CT评估分流道通畅情况及腹腔出血情况。结果 6头健康家猪均一针穿刺成功并建立肝外门腔分流道,6头术中分流道造影均无对比剂外溢;1头于手术当天死于麻醉过量,2头于术后3 d分流道失效(1头分流道闭塞,另1头狭窄80%)。另3头于术后2周分流道闭塞。6头尸检证实分流道均位于肝外且无腹腔出血。结论 X射线引导下经颈内静脉建立肝外门腔分流道是安全、可行的。
Objective To explore the feasibility and safety of establishing an extrahepatic portal shunt by X-ray guided direct transcatheterization of the extrahepatic portal vein from the inferior vena cava via the internal jugular vein. Method 6 healthy domestic pigs, ultrasound guided percutaneous transhepatic approach, into the 5F pigtail catheter in the main portal vein for the target catheter. Ultrasound guided by the internal jugular vein path, into RUPS-100 puncture system in the inferior vena cava. Under X-ray guidance, the target catheter was punctured from the inferior vena cava and the extrahepatic portosystemic shunt was established by Fluency stent. At 3 days and 2 weeks after operation, total abdomen enhancement CT was used to assess the status of shunt patency and intraperitoneal hemorrhage. Results All the 6 healthy pigs were successfully punctured with one needle and established extrahepatic portosystemic shunt. Six of them had no effusion of contrast medium. One died on the day of surgery and the other two died on the third day after operation Road failure (a shunt occlusion, the other a narrow 80%). The other three in two weeks after the shunt occlusion. 6 autopsy confirmed shunt are located outside the liver and no intra-abdominal bleeding. Conclusion It is safe and feasible to establish extrahepatic portal shunt through X-ray guided internal jugular vein.