A STUDY OF PERCUTANEOUS TRANSHEPATIC INTRAHEPATIC PORTOSYSTEMIC SHUNT

本研究对经颈静脉肝内门体静脉分流术（TIPS）的穿刺方法进行了探讨。A）实验研究a）穿刺方法：实验：为了建立一种更安全的TIPS穿刺方法，我们提出了一种新的经皮穿刺技术，在超声（US）技术下经肝穿刺门静脉和肝静脉。使用犬，我们比较了这种技术与传统的经颈静脉技术，通过肝静脉穿刺门静脉使用罗斯针（罗斯针技术）。US技术成功率为100%，Ross针技术成功率为50%。Ross针技术出现腹腔内出血等严重并发症，而US技术无并发症。结论：TIPSS穿刺方法中，超声技术较Ross针穿刺方法安全可靠。B）通道闭合：经皮穿刺形成一条连接门体分流的通道，用不锈钢弹簧圈成功闭合。 ...更多信息 大小合适。c）最佳金属支架：Wallstent（Shneider C. C）因其柔软、弯曲、扩张力大，是TIPS最佳的金属支架。B）临床研究：我们用这种方法为一位64岁的男性患者建立了一个肝内门体分流术。超声检查可见肝右叶萎缩，肝内门静脉几乎不可见。所以，我们试着在左叶形成shnt。成功地建立了门静脉左支至肝左支的分流术，未发现并发症，但3个月后分流道阻塞。这样做的部分原因是金属支架没有完全覆盖到门静脉中。结论：经皮冠状动脉分流术是治疗TIPS的一种新的安全的方法。少

We studied of TIPS(Transjugular Intrahepatic Portosystemic Stent Shunt) abou percutaneous transhepatic method.A)Experimental Study a)Puncture method : Experiment : To establish a safer puncture method for TIPS, we developed a new percutaneous puncture technique to penetrante portal and hepatic vein transhepatically uner ultrasonography(US technique). Using canines we compared this technique with conventional transjugular technique puncturing portal vein through hepatic vein using Ross needle(Ross Needle technique). Success rate is 100% in US technique and 50% in Ross needle technique. Severe complication including intraperitoneal bleeding occurred in Ross needle technique, but no complication is US technique. Conclusively, US technique is a safer and more reliable method than that using Ross needle in the puncture method for TIPSS.b)Tract closure ; A tract formed percutaneoluly tanshepatically, which connects portosystemic shunt, was successfully colsed with stainless steel coils of va … More rous sizes. c)Optimal metallic stent : Wallstent (Shneider C.C) was the best suitable stent for TIPS because of its softness, bending ability, expansile force. d)Dilatation of Unmbilical Vein : Rabbit or canine umbilical vein was so small that we could not dilate its vein experimentally.B)Clinical Study : We formed an intrahepatic portosystemic shunt usign this method for a 64-year-old male with marked esophageal varix and liver cirrhosis, hepatic tumor. On ultrasonography, right lobe of the liver was shrunken and intrahepatic portal vein was hardly visible. So, we tried shnt formation in the left lobe. A shunt from left portal vein to left hepatic vein was successfully made and no complication was found. However, the shunt was obstructed after 3 months. This was done partly because metallic stent was not fully covered into the portal vein. Now, we are studying a new utilization of this transhepatic method to TIPS.C)Conclusion : Our study revealed the transhepatic shunt formation to be a new and safe choice for TIPS. Less