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目的初步探讨覆膜支架成形术治疗癌栓性门静脉狭窄的技术要点及早期疗效。方法 5例原发性肝癌和1例胆总管癌患者,增强 CT 显示门静脉癌栓形成致门静脉主干狭窄超过75%(2例闭塞)。采用经皮、经肝与经皮、经脾途径介入治疗,在狭窄部位放置直径10 mmFLUENCYT~(TM)覆膜支架,术后以氰基丙烯酸正丁酯(NBCA)胶栓塞曲张胃冠状静脉及穿刺通道。支架置入前、后测量门静脉压力。结果 6例患者手术全部成功,支架成形前门静脉压力平均50.7 cmH_2O(1 cm H_2O=0.098 kPa),术后平均41.3 cm H_2O,平均降低9.4 cm H_2O。1个月后复查,2例支架内栓子形成,再狭窄,出现呕血、大量腹水症状,其余4例患者未发生门静脉高压导致的严重症状。结论覆膜支架成形术治疗癌栓性门静脉狭窄安全可行,选择合适的适应证能有效控制门静脉高压的症状。
Objective To investigate the technical points and early curative effect of stent-graft in the treatment of thrombus-induced portal vein stenosis. METHODS: Five patients with primary hepatocellular carcinoma and one with cholangiocarcinoma showed enhanced portal stenosis of more than 75% of the main portal vein stenosis (2 occlusions) with enhanced CT. Percutaneous, transhepatic, transdermal and transvenous routes of interventional therapy were used. Stents with a diameter of 10 mm FLUENCYT TM were placed in the stenotic area. Coronary vein was dissected with NBCA glue Puncture channel. Portal stent pressure before and after measurement. Results All the operations were successful in 6 patients. The mean portal vein pressure was 50.7 cmH 2 O (1 cm H 2 O = 0.098 kPa) after stent implantation. The average postoperative 41.3 cm H 2 O was 9.4 cm H 2 O. One month after the review, two cases of stent emboli formation, restenosis, vomiting, massive ascites symptoms, and the remaining four patients did not occur serious symptoms caused by portal hypertension. Conclusion Stent grafting is safe and feasible for the treatment of thrombus-induced portal vein stenosis. Choosing appropriate indications can effectively control the symptoms of portal hypertension.