Percutaneous retroperitoneal splenorenal shunt : an experimental study in swine

TIPS（经颈静脉肝内门静脉分流术）是众所周知的治疗静脉曲张的有效方法，但它也有一些并发症。尤其是肝性脑病是严重的并发症之一。我们开发了经皮腹膜后脾肾分流术（PRESS），作为一种新的无肝性脑病的门静脉-全身分流术，并在猪身上进行了实验研究。首先，我们做了一个特殊的穿刺装置。我们使用有盖金属支架经股动脉入路经腹膜后腔进行脾肾分流术。在急性研究中，我们成功地创建了分流，没有任何并发症。脾静脉与下腔静脉之间的压力梯度在分流术后立即下降。在慢性研究中，大多数动物的分流管阻塞或严重变窄持续1至4周。大体检查显示所有支架均位于腹膜后腔，未见腹膜内出血。按压相对容易，本研究未见重大并发症。所有实验过程仅由透视引导，但在临床环境中，超声引导可避免穿透胰腺实质。肝硬化患者脾静脉较容易穿刺，因为脾静脉较宽，离左肾静脉较近。我们已经证明加压术在技术上是可行的，并且是门脉高压的一种潜在的新治疗方法。进一步的实验研究是必要的，以评估加压是否有效的长期缓解门静脉高压症，如果它可以替代或替代TIPS。

TIPS (Transjugular intrahepatic portosystemic shunt) is well known as an effective method for varices, but it has several complications. Especially hepatic encephalopathy is one of serious complications. We developed percutaneous retroperitoneal splenorenal shunt (PRESS) as a new procedure creating porto-systemic shunt without hepatic encephalopathy, and performed an experimental study in swine. First we made a special puncture set. We created a spleno-renal shunt through the retroperitoneal cavity by the transfemoral approach using a covered metallic stent. In the acute study we successfully created the shunt without any complications. Pressure gradient between the splenic vein and the IVC decreased immediately after the shunt creation. In the chronic study the shunt was obstructed or severely narrowed in most of the animals for 1 to 4 weeks. Gross inspection revealed that all stent-grafts were located in the retroperitoneal cavity and there was no intraperitoneal hemorrhage. PRESS was done with relative ease, and no major complication was observed in this study. All experimental procedures were guided only by fluoroscopy, but in a clinical setting ultrasonographic guidance could be used to avoid the penetration of the pancreatic parenchyma. In the case with liver cirrhosis the puncture of the splenic vein might be easier, because the splenic vein is wide and relatively close to the left renal vein.We have shown that PRESS is technically feasible and is a potential new treatment for portal hypertension. Further experimental studies are necessary to evaluate if PRESS is effective in long term relief of portal hypertension and if it can be an alternative or replacement of TIPS.