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TIPS 那点儿事儿(2)

时间:2021-07-02 12:14来源:www.ynjr.net 作者:杨宁介入医学网
TIPS 病例 TIPS 病例 1 经颈静脉肝静脉导管术 门静脉穿刺成功后造影 造影后期 造影后期 支撑架植入后 支撑架植入后造影 病例2:经左肝静脉-左门静脉穿刺,支撑架植入术 肝静脉导管术,位置过低 左肝静脉导管术 经左



TIPS 病例

TIPS 病例 1
经颈静脉肝静脉导管术 门静脉穿刺成功后造影
造影后期 造影后期
支撑架植入后 支撑架植入后造影




病例2:经左肝静脉-左门静脉穿刺,支撑架植入术
肝静脉导管术,位置过低 左肝静脉导管术
经左肝静脉穿刺门静脉成功 门静脉造影
门静脉造影 门静脉造影
球囊扩张 球囊扩张导管
支撑架植入 支撑架植入后造影



病例3:门静脉血栓TIPS
经右肝静脉门静脉导管术,显示门静脉血栓 经导管门静脉造影,显示门静脉阻塞
逐段球囊扩张 逐段球囊扩张
门静脉逐段球囊扩张 门静脉-肠系膜上静脉逐段球囊扩张
肝实质与肝静脉交界扩张 换大球囊再扩张
门静脉支撑架植入后造影 造影后期
   




经肝静脉门静脉穿刺成功后造影 球囊扩张后造影
支撑架植入后 支撑架内球囊扩张
逐段球囊支撑架内扩张 扩张后造影,技术满意
支撑架植入完成 最后造影



肠系膜上静脉血栓TIPS

右肝静脉造影,不规则显影 左肝静脉造影
经右肝静脉穿刺进入肠系膜上静脉血栓 导管导丝直至肠系膜静脉的近端开放属支
肠系膜上静脉血栓内逐段直径较小球囊扩张 肠系膜上静脉内逐段扩张,静脉曲张得到显示
肠系膜上静脉逐段扩张 扩张后造影,门静脉主干显影
门静脉主干造影,左侧门脉显影 换直径10mm大球囊扩张
换大球囊逐段扩张 换大球囊逐段扩张
大球囊扩张后造影 大球囊扩张后造影
大球囊扩张后造影 最后扩张右肝静脉与右侧门脉之间肝实质
支撑架植入 支撑架植入后造影


(未完待续)

1. Henderson et al. Distal splenorenal shunt versus transjugular intrahepatic portal systemic shunt for variceal bleeding: A randomized trial. Gastroenterology 2006; 130:1643-1651

2. Boyer and Haskal. The role of Transjugular Intrahepatic Portosystemic Shunt in the management of portal hypertension. AASLD Practice Guideline. Hepatology, Feb 2005. Update 2009 (Hepatology Jan 2010)

3. Boyer and Haskal. The role of Transjugular Intrahepatic Portosystemic Shunt in the management of portal hypertension. AASLD Practice Guideline. Hepatology, Feb 2005. Update 2009 (Hepatology2010)

4. Fillmore DJ et al. Transjugular intrahepatic portosistemic shun: midterm clinical and angiografic follow-up.JVIR 1996

5. Haskal ZJ et al.Transjugular intrahepatic portosystemic shunt stenosis and revision: early and midterm results. AJR 1994

6. Saxon RS et al. Transjugular intrahepatic portosystemic shunt patency and the importance of stenosis location in the development of recurrent symptoms. Radiology 1998.

7. Otal P et al .Preliminary results of a new expanded-polytetrafluoroethylene-covered stent graft for trnasjugular intrahepatic portosystemic shunt procedures.AJR 2002

8. Cejna M et al.Creation of trnasjugular intrahepatic portosystemic shunts with stent-grafts:initial experiences with a polytetrafluoroethylene-covered nitinol endpprosthesis.Radiology 2001

9. Hausegger KA et al.Transjugular intrahepatic portosystemic shunt creation with the Viatorr expanded polytetrafluoroethylene-covered stent-graft.JVIR 2004

10. Bureau et al, Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: Results of a randomized study. Gastroenterology 2004

11. Bureau et al, Patency of stents covered with polytetrafluoroethylenein patients treated by trans-jugular porto-systemic shunts: long-term results of a randomized multicentre study. Liver Int 2007

12. Bryan Peterson et al. Intravascular Ultrasound-guided Direct Intrahepatic Portocaval Shunt: Mid-term Follow-up. JVIR Set. 2004
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