CO_2楔入肝静脉造影在肝硬化急性上消化道出血的TIPS术中的作用
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摘要
目的探讨急性肝硬化并消化道出血采用经颈静脉肝内门体分流术(TIPS)中行CO_2楔入肝静脉造影逆行显示门静脉在指导门静脉穿刺中的作用。方法回顾性分析2010年6月～2018年6月中国人民解放军总医院第六医学中心40例急性上消化出血患者的临床资料,所有患者均行TIPS,并行门静脉穿刺前的楔入法肝静脉造影。根据入院时间进行分组,其中20例患者采用CO_2造影(A组),另20例采用碘佛醇造影(B组)。评估两组造影显示门静脉主干和左右分支情况,比较两组门静脉穿刺次数、穿刺所需时间以及两组穿刺成功率。结果 A组中有17例患者清晰显示门静脉主干和左右分支,B组中有5例患者显示门静脉主干和左右分支,A组显影质量优于B组,两组比较差异有高度统计学意义(P <0.01)。A组平均门静脉穿刺次数少于B组,组间比较差异有高度统计学意义(P <0.01)。A组门静脉穿刺时间少于B组,组间比较差异有高度统计学意义(P <0.01)。两组穿刺成功率均为100%,组间差异无统计学意义(P> 0.05)。两组均未发生严重不良反应。结论在肝硬化急性上消化道出血的患者TIPS术中,用CO2楔入肝静脉造影可以较好显示门静脉的主干和左右分支,引导门静脉穿刺,减少穿刺次数,缩短穿刺时间,值得临床推广应用。
Objective To investigate the efficacious of wedged hepatic venography with CO_2 for guiding portal vein puncture during transjugular intra-hepatic porto-systemic shunt(TIPS) in the treatment of acute upper gastro-intestinal bleeding due to liver cirrhosis. Methods Clinical data of 40 patients with acute upper gastro-intestinal hemorrhage due to rupture of esophageal or gastric varicose veins in liver cirrhosis underwent TIPS in the Sixth Medical Center, Chinese People′ s Liberation Army General Hospital from June 2010 to June 2018 were analyzed retrospectively. All patients received wedged hepatic venography before TIPS. Among the patients, 20 cases were performed hepatic venography with CO_2(groups A), and the other 20 cases were performed hepatic venography with Ioversol(group B) according to the admission time. Visualization of the main portal vein and its′ branch in the two groups were evaluated. The frequency, time of portal vein puncture in the two groups were compared. The successful portal vein puncture rate of the two groups were compared. Results There were 17 cases had clear display portal vein trunk and its main branches in group A, and 5 cases had clear display portal vein trunk and its main branches in group B, imaging quality in group A was better than group B, the difference was highly statistically significant(P < 0.01). The average frequency of portal vein puncture in the group A was fewer than the group B, the difference was highly statistically significant(P < 0.01). Time of portal vein puncture in the group A was less than that in the group B, the difference was highly statistically significant(P < 0.01). Successful portal vein puncture rate were both 100% in the two groups, and there was no statistically significant difference(P > 0.05). There were no severe adverse reactions in the two groups. Conclusion Wedged hepatic venography with CO2 is effective in visualization of portal vein and its branches for guiding portal vein puncture during TIPS in the treatment of acute upper gastro-intestinal bleeding in liver cirrhosis. It can guide portal vein puncture,reduce puncture times and shorten puncture time, which is worthy of clinical promotion.
Objective To investigate the efficacious of wedged hepatic venography with CO_2 for guiding portal vein puncture during transjugular intra-hepatic porto-systemic shunt(TIPS) in the treatment of acute upper gastro-intestinal bleeding due to liver cirrhosis. Methods Clinical data of 40 patients with acute upper gastro-intestinal hemorrhage due to rupture of esophageal or gastric varicose veins in liver cirrhosis underwent TIPS in the Sixth Medical Center, Chinese People′ s Liberation Army General Hospital from June 2010 to June 2018 were analyzed retrospectively. All patients received wedged hepatic venography before TIPS. Among the patients, 20 cases were performed hepatic venography with CO_2(groups A), and the other 20 cases were performed hepatic venography with Ioversol(group B) according to the admission time. Visualization of the main portal vein and its′ branch in the two groups were evaluated. The frequency, time of portal vein puncture in the two groups were compared. The successful portal vein puncture rate of the two groups were compared. Results There were 17 cases had clear display portal vein trunk and its main branches in group A, and 5 cases had clear display portal vein trunk and its main branches in group B, imaging quality in group A was better than group B, the difference was highly statistically significant(P < 0.01). The average frequency of portal vein puncture in the group A was fewer than the group B, the difference was highly statistically significant(P < 0.01). Time of portal vein puncture in the group A was less than that in the group B, the difference was highly statistically significant(P < 0.01). Successful portal vein puncture rate were both 100% in the two groups, and there was no statistically significant difference(P > 0.05). There were no severe adverse reactions in the two groups. Conclusion Wedged hepatic venography with CO2 is effective in visualization of portal vein and its branches for guiding portal vein puncture during TIPS in the treatment of acute upper gastro-intestinal bleeding in liver cirrhosis. It can guide portal vein puncture,reduce puncture times and shorten puncture time, which is worthy of clinical promotion.
引文
[1]牛猛,孙骏,徐克,等.经颈静脉肝内门体分流术应用的回顾与展望[J].临床肝胆病杂志,2016,32(2):230-233.
[2]陈辉,吕勇,王秋和,等.经颈静脉肝内门体分流术专家共识[J].临床肝胆病杂志,2017,33(6):1218-1227.
[3] Rouabah K,Varoquaux A,Caporossi JM,et al. Image fusion-guided portal vein puncture during transjugular intrahepatic portosystemic shunt placement[J]. Diagn Interv Imaging,2016,97(11):1095-1102.
[4] Fidelman N,Kwan SW,LaBerge JM,et al. The transjugular intrahepatic portosystemic shunt:an update[J]. Am J Roentgenol,2012,199(4):746-755.
[5] Caporossi JM,Vidal V,Jacquier A,et al. Balloon occlusion versus wedged hepatic venography using iodinated contrast for targeting the portal vein during TIPS[J]. Diagn Interv Imaging,2015,96(4):357-363.
[6] Krajina A,Hulek P,Fejfar T,et al. Quality improvement guidelines for Transjugular Intrahepatic Portosystemic Shunt(TIPS)[J]. Cardiovasc Intervent Radiol,2012,35(6):1295-1300.
[7] Jourabchi N,McWilliams JP,Lee EW,et al. TIPS placement via combined transjugular and transhepatic approach for cavernous portal vein occlusion:targeted approach[J].Case Rep Radiol,2013,2013:5. doi:10.1155/2013/635391.635391.
[8] Haskal ZJ,Martin L,Cardella JF,et al. Quality improvement guidelines for transjugular intrahepatic portosystemic shunts[J]. J Vasc Interv Radiol,2001,12(2):131-136.
[9]卢伟,李彦豪,何晓峰,等.二氧化碳肝动脉造影显示门静脉癌栓中的作用[J].中国医学物理学杂志,2010,27(5):2150-2152
[10]卢伟,杨超,张嘉诚,等.CO2-DSA在小肠出血诊断中的价值[J].中国医药导报,2018,15(10):118-121.
[11] Krajina A,Lojik M,Chovanec V,et al. Wedged hepatic venog-raphy for targeting the portal vein during TIPS:comparison of carbon dioxide and iodinated contrast agents[J]. Cardiovasc Intervent Radiol,2002,25(3):171-175.
[12] Theuerkauf I,Strunk H,Brensing KA,et al. Infarction and laceration of liver parenchyma caused by wedged CO2venography before tips insertion[J]. Cardiovasc Intervent Radiol,2001,24(1):64-67.
[13] Takeuchi Y,Morikage N,Matsuno Y,et al. Midterm Outcomes of Endovascular Aortic Aneurysm Repair with Carbon Dioxide-Guided Angiography[J]. Ann Vasc Surg,2018,51(2):170-176.
[14] Kishino M,Nakaminato S,Kitazume Y,et al. BalloonOccluded Carbon Dioxide Gas Angiography for Internal Iliac Arteriography and Intervention[J]. Cardiovasc Intervent Radiol,2018,41(7):1106-1111.
[15] Chacko S,Joseph G,Thomson V,et al. Carbon dioxide Angiography-Guided Renal-Related Interventions in Patients with Takayasu Arteritis and Renal Insufficiency[J].Cardiovasc Intervent Radiol,2018,41(7):998-1007.
[16] Mascoli C,Faggioli G,Gallitto E,et al. Standardization of a Carbon Dioxide Automated System for Endovascular Aortic Aneurysm Repair[J]. Ann Vasc Surg,2018,51(2):160-169.
[17] Hameed MA,Freedman JS,Watkin R,et al. Renal denervation using carbon dioxide renal angiography in patients with uncontrolled hypertension and moderate to severe chronic kidney disease[J]. Clin Kidney J,2017,10(6):778-782.
[18] Sharafuddin MJ,Marjan AE. Current status of carbon dioxide angiography[J]. J Vasc Surg,2017,66(2):618-637.
[19] De Angelis C,Sardanelli F,Perego M,et al. Carbon dioxide(CO2)angiography as an option for endovascular abdominal aortic aneurysm repair(EVAR)in patients with chronic kidney disease(CKD)[J]. Int J Cardiovasc Imaging,2017,33(11):1655-1662.
[20] Kawashita S,Kaneuchi M,Nakayama D,et al. Carbon dioxide angiography and arterial embolization could successfully control postpartum uterine hemorrhage for the patient with hypersensitivity to iodine compound[J]. Radiol Case Rep,2017,12(2):261-264.
[2]陈辉,吕勇,王秋和,等.经颈静脉肝内门体分流术专家共识[J].临床肝胆病杂志,2017,33(6):1218-1227.
[3] Rouabah K,Varoquaux A,Caporossi JM,et al. Image fusion-guided portal vein puncture during transjugular intrahepatic portosystemic shunt placement[J]. Diagn Interv Imaging,2016,97(11):1095-1102.
[4] Fidelman N,Kwan SW,LaBerge JM,et al. The transjugular intrahepatic portosystemic shunt:an update[J]. Am J Roentgenol,2012,199(4):746-755.
[5] Caporossi JM,Vidal V,Jacquier A,et al. Balloon occlusion versus wedged hepatic venography using iodinated contrast for targeting the portal vein during TIPS[J]. Diagn Interv Imaging,2015,96(4):357-363.
[6] Krajina A,Hulek P,Fejfar T,et al. Quality improvement guidelines for Transjugular Intrahepatic Portosystemic Shunt(TIPS)[J]. Cardiovasc Intervent Radiol,2012,35(6):1295-1300.
[7] Jourabchi N,McWilliams JP,Lee EW,et al. TIPS placement via combined transjugular and transhepatic approach for cavernous portal vein occlusion:targeted approach[J].Case Rep Radiol,2013,2013:5. doi:10.1155/2013/635391.635391.
[8] Haskal ZJ,Martin L,Cardella JF,et al. Quality improvement guidelines for transjugular intrahepatic portosystemic shunts[J]. J Vasc Interv Radiol,2001,12(2):131-136.
[9]卢伟,李彦豪,何晓峰,等.二氧化碳肝动脉造影显示门静脉癌栓中的作用[J].中国医学物理学杂志,2010,27(5):2150-2152
[10]卢伟,杨超,张嘉诚,等.CO2-DSA在小肠出血诊断中的价值[J].中国医药导报,2018,15(10):118-121.
[11] Krajina A,Lojik M,Chovanec V,et al. Wedged hepatic venog-raphy for targeting the portal vein during TIPS:comparison of carbon dioxide and iodinated contrast agents[J]. Cardiovasc Intervent Radiol,2002,25(3):171-175.
[12] Theuerkauf I,Strunk H,Brensing KA,et al. Infarction and laceration of liver parenchyma caused by wedged CO2venography before tips insertion[J]. Cardiovasc Intervent Radiol,2001,24(1):64-67.
[13] Takeuchi Y,Morikage N,Matsuno Y,et al. Midterm Outcomes of Endovascular Aortic Aneurysm Repair with Carbon Dioxide-Guided Angiography[J]. Ann Vasc Surg,2018,51(2):170-176.
[14] Kishino M,Nakaminato S,Kitazume Y,et al. BalloonOccluded Carbon Dioxide Gas Angiography for Internal Iliac Arteriography and Intervention[J]. Cardiovasc Intervent Radiol,2018,41(7):1106-1111.
[15] Chacko S,Joseph G,Thomson V,et al. Carbon dioxide Angiography-Guided Renal-Related Interventions in Patients with Takayasu Arteritis and Renal Insufficiency[J].Cardiovasc Intervent Radiol,2018,41(7):998-1007.
[16] Mascoli C,Faggioli G,Gallitto E,et al. Standardization of a Carbon Dioxide Automated System for Endovascular Aortic Aneurysm Repair[J]. Ann Vasc Surg,2018,51(2):160-169.
[17] Hameed MA,Freedman JS,Watkin R,et al. Renal denervation using carbon dioxide renal angiography in patients with uncontrolled hypertension and moderate to severe chronic kidney disease[J]. Clin Kidney J,2017,10(6):778-782.
[18] Sharafuddin MJ,Marjan AE. Current status of carbon dioxide angiography[J]. J Vasc Surg,2017,66(2):618-637.
[19] De Angelis C,Sardanelli F,Perego M,et al. Carbon dioxide(CO2)angiography as an option for endovascular abdominal aortic aneurysm repair(EVAR)in patients with chronic kidney disease(CKD)[J]. Int J Cardiovasc Imaging,2017,33(11):1655-1662.
[20] Kawashita S,Kaneuchi M,Nakayama D,et al. Carbon dioxide angiography and arterial embolization could successfully control postpartum uterine hemorrhage for the patient with hypersensitivity to iodine compound[J]. Radiol Case Rep,2017,12(2):261-264.