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【目的】探讨经下腔静脉 (IVC)肝内穿刺介入操作 ,包括肝静脉造影、第二肝门重建术 (RSHH)和直接肝内门腔分流术 (DIPS)的临床应用。【方法】回顾性分析 11例经IVC肝内穿刺介入操作 ,评价临床疗效。【结果】 11例成功行经IVC内穿刺操作 ,①经IVC肝内穿刺肝静脉造影及第二肝门重建术 :其中 7例行第二肝门重建术 ,术后门脉高压症状明显改善 5例 ,轻度改善 2例 ;1例IVC阻塞症状轻度改善 ;4例消化道出血患者中 ,3例术后 8个月～ 3年均再无发生 ,1例术后 1个月再发急性出血 ;另 2例只行肝静脉造影 ;②直接肝内门腔分流术 :共 2例 ,术后门脉高压症状均明显改善 ,分别于术后 2年及 4年内未发生消化道出血。【结论】①经IVC肝内穿刺肝静脉造影可准确评价肝静脉和门静脉系统血流动力学状况 ;②经IVC途径的第二肝门重建术穿刺安全 ,成功率高。重建通道效果明确 ,术后狭窄少 ;③DIPS优点是穿刺安全简便 ,分流效果好。保护正常肝静脉 ,减少胆道损伤 ,术后狭窄少。
【Objective】 To investigate the clinical application of transcatheter hepatic vein puncture through inferior vena cava (IVC), including hepatic venography, second hepatic portal reconstruction (RSHH) and direct intrahepatic portosystemic shunt (DIPS). 【Methods】 A retrospective analysis of 11 cases of IVC intrahepatic puncture interventional operation, evaluation of clinical efficacy. 【Results】 Eleven patients successfully underwent IVC puncture. ① Hepatic vein angiography with IVC and hepatic portal reconstruction were performed in 7 cases. Among them, 7 cases underwent second hepatic portal reconstruction, and postoperative symptoms of portal hypertension were significantly improved in 5 cases , Mild improvement in 2 cases; 1 case of mild symptoms of obstruction improved IVC; 4 cases of gastrointestinal bleeding in patients, 3 cases of postoperative 8 months to 3 years were no recurrence, 1 case 1 month after the recurrence of acute bleeding ; The other 2 cases only hepatic venography; ② direct intrahepatic portosystemic shunt: a total of 2 cases, postoperative portal hypertension symptoms were significantly improved, respectively, within 2 years and 4 years after the absence of gastrointestinal bleeding. 【Conclusions】 ¢ ô Hepatic vein and portal vein system hemodynamics can be accurately evaluated by intrahepatic IVC hepatic venography; ¢ ÚSecond hepatic portal reconstruction by IVC is safe and the success rate is high. Reconstruction of the channel clear, less postoperative stenosis; ③DIPS advantages of puncture safe and easy, shunt effect. Protect the normal hepatic vein, reduce bile duct injury, less postoperative stenosis.