经颈静脉楔入法肝静脉CO2造影术在经颈静脉肝内门体分流术中的应用

摘要

目的 改进经颈静脉肝内门体分流术(TIPS)门静脉造影方法,探索安全、省时的肝静脉造影和手术方法.方法 对6例经颈静脉楔入法肝静脉CO2造影和7例穿刺股动脉经肠系膜下动脉间接门静脉显影方法进行对比,评价2种门静脉造影方法的门静脉图像质量、TIPS手术效果、患者 术后并发症发生情况及恢复情况.结果 6例楔入法肝静脉CO2造影均获得满意图像,因为凝血功能差终止手术1例,5例手术成功.7例穿刺股动脉经肠系膜下动脉间接门静脉造影获得手术所需图像,1例因门静脉慢性梗阻手术失败,6例手术成功,其中1例术后动脉穿刺点出现血肿.结论 在TIPS手术中,应用楔入法肝静脉CO2造影较肠系膜下动脉造影显示门静脉解剖结构更清晰、方便和安全.%Objective To renovate angiography in identifying portal vein anatomy during transjugular intrahepatic portosystemic shunt (TIPS) procedures,saving the time of TIPS procedures,decreasing the risk of the complications of the post-procedure.Methods The difference between the Wedge hepatic venography with Carbon Dioxide in 6 cases and Inferior Mesenteric artery angiography in 7 cases during TIPS procedures were compared in the identification of portal vein anatomy.The quality of images,their effects on the procedures,the complications and the recovery post-procedure were evaluated.Results Using CO2,the portal veins were opacified in all 6 cases.TIPS procedures succeeded in all cases except 1 case because of poor coagulation function.Using Inferior Mesenteric artery angiography,the portal veins were opacified in al1 7 cases.TIPS procedure succeeded in all cases except 1 case because of chronic portal occlusion.Puncture-site hematoma occurred in 1 case after TIPS procedure.Conclusion Wedge hepatic venography with Carbon Dioxide is superior,safer and more convenient than Inferior Mesenteric Artery angiography in identifying portal vein anatomy during TIPS.