Application of transmesenteric vein extrahepatic portosystemic shunt to treat extrahepatic portal vein obstructive disease
10.3760/cma.j.cn112149-20210527-00512
- VernacularTitle:经肠系膜上静脉肝外门体分流术在肝外门静脉阻塞病变治疗中的应用价值
- Author:
Weixiao LI
1
;
Mingzhe CUI
;
Deyang SONG
;
Jiangbo CHEN
;
Danghui LU
;
Dongbin ZHANG
;
Shuiting ZHAI
Author Information
1. 郑州大学人民医院 河南省人民医院血管外科 450003
- Keywords:
Portosystemic shunt, surgical;
Extrahepatic portal vein obstructive disease;
Portal vein thrombosis;
Cavernous transformation of the portal vein
- From:
Chinese Journal of Radiology
2021;55(9):903-909
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the feasibility, safety and effectivity of applying transmesenteric vein extrahepatic portosystemic shunt (TEPS) to treat extrahepatic portal vein obstructive disease (EHPVOD).Methods:From December 2020 to April 2021, 12 patients with EHPVOD in the Vascular Surgery Department of Zhengzhou University People′s Hospital were prospectively enrolled in the study. The infra-umbilical median longitudinal minilaparotomy was performed to expose the branch of superior mesenteric vein (SMV). RUPS-100 was introduced into the trunk of SMV. A balloon with a diameter of 20 mm was introduced through right internal jugular vein (RIJV) into inferior vena cava (IVC). Under fluoroscopy, RUPS-100 was used to puncture the balloon in IVC. A stiff guide wire was used to establish the pathway between RIJV and SMV. Finally the portosystemic shunt between IVC and SMV was established with a covered stent-graft. The total operative time, the time of establishing portosystemic shunt alone, the dosage of contrast agent, the preoperative and postoperative pressure of SMV were recorded. Paired t test was used to compare the preoperative and postoperative pressure of SMV. Results:All 12 patients were successfully performed TEPS. The total operative time was (113±32) min, the time of establishing portosystemic shunt alone was (31±5) min, the dosage of contrast agent was (129±48) ml. The postoperative pressure of SMV [(14.3±2.1) mmHg] decreased significantly ( t=20.125, P<0.01) compared to baseline [(27.8±2.7) mmHg]. All portal hypertension symptoms released after the operations.There was 1 case of delayed incision healing, 1 case of bacteremia and 1 case of slight hepatic encephalopathy, but all of them were cured. There was no death case. Postoperative CT showed all portosystemic shunts were patent. Conclusion:TEPS is a new, safe, effective and feasible treatment method for patients of acute and chronic EHPVOD.
