目的:本研究旨在评估可行性,安全,经颈静脉肠系膜腔分流术(TMCS)治疗门静脉海绵样变(CTPV)和复发性静脉曲张出血的疗效。
方法:本回顾性病例系列是在机构审查委员会的批准下进行的。它涉及7例诊断为CTPV和复发性静脉曲张破裂出血的患者,他们接受了TMCS手术。我们分析了手术并发症的发生率,再出血事件,支架狭窄,肝性脑病,和总生存期以评估治疗结果。
结果:在所有7例患者中成功进行了TMCS,没有任何危及生命的并发症。术后,一名患者出现肺部感染和胸腔积液,通过适当的治疗解决。此外,两名患者总胆红素水平升高,但肝功能没有进一步恶化。中位门静脉压力梯度从术前的27mmHg(范围20-36mmHg)显着降低到术后的6mmHg(范围4-11mmHg)。在一名肝硬化患者中观察到显着改善,肝功能从Child-PughB级(9分)发展到A级(6分)。中位随访期为14个月(范围7-18个月),没有病人再出血,支架狭窄,肝性脑病,或死亡率。
结论:TMCS似乎是治疗复发性静脉曲张破裂出血的可行且有效的替代方法。其长期结果需要进一步评估。
结论:当闭塞的门静脉不能再通并且门静脉再通TIPS不是一种选择时,TMCS为患有危及生命的CTPV并发症的患者提供了一种有希望的治疗方法。
结论:在门静脉海绵体瘤患者中进行TIPS是复杂的,因为需要对闭塞的门静脉进行再通。通过经颈静脉入路创建肠系膜腔分流是一种可行的技术。建立TMCS提供了一种方法来管理由门静脉海绵体瘤引起的危及生命的并发症。
OBJECTIVE: This study aimed to evaluate the feasibility, safety, and efficacy of the transjugular mesenteric-caval shunt (TMCS) as a treatment for the cavernous transformation of the portal vein (CTPV) and recurrent variceal bleeding.
METHODS: This retrospective case series was conducted with approval from the institutional review board. It involved seven patients diagnosed with CTPV and recurrent variceal bleeding who underwent the TMCS procedure. We analyzed the rate of procedural complications, incidents of rebleeding, stent stenosis, hepatic encephalopathy, and overall survival to assess treatment outcomes.
RESULTS: The TMCS was successfully performed in all seven patients without any life-threatening complications. Postoperatively, one patient developed a lung infection and pleural effusion, which resolved with appropriate treatment. Additionally, two patients experienced an increase in total bilirubin levels, but there was no further deterioration in liver function. The median portal pressure gradient significantly decreased from a preoperative value of 27 mmHg (range 20-36 mmHg) to a postoperative value of 6 mmHg (range 4-11 mmHg). A notable improvement was observed in one cirrhotic patient, with liver function progressing from Child-Pugh class B (score 9) to class A (score 6). Over a median follow-up period of 14 months (range 7-18 months), none of the patients encountered rebleeding, stent stenosis, hepatic encephalopathy, or mortality.
CONCLUSIONS: The TMCS appears to be a viable and effective alternative for managing CTPV with recurrent variceal bleeding. Its long-term outcome requires further evaluation.
CONCLUSIONS: TMCS provides a promising treatment for patients with life-threatening CTPV complications when occluded portal vein cannot be recanalized and portal vein recanalization TIPS is not an option.
CONCLUSIONS: Performing TIPS in patients with portal vein cavernoma is complex due to the requirement for recanalization of the occluded portal vein. Creating a mesenteric-caval shunt through a transjugular approach is a feasible technique. Establishing a TMCS provides a means to manage life-threatening complications arising from portal vein cavernoma.