经肝段下腔静脉建立TIPS分流道的初步临床结果

目的 评估经肝段下腔静脉TIPS分流术在肝静脉与门静脉间解剖异常时操作的可行性，讨论其临床意义。方法 65例肝硬变门静脉高压患者行经肝段下腔静脉直接穿刺门静脉完成TIPS分流术。结果 65经肝段下腔静脉TIPS分流术均获成功，技术成功率100％，未出现术中技术相关并发症，一年内再狭窄率明显低于常规TIPS，3例肝性脑病经限流支架置入得以控制。结论 经肝段下腔静脉TIPS分流术技术用于肝静脉与门静脉间解剖异常病例是安全有效的，同时提示由于肝内分流道曲度较小，一年内支架开通率明显提高。

Transcaval transjugular intrahepatic portosystemic shunt:preliminary clinical results

Objective To determine the feasibility of transcaval transjugular intrahepatic portosystemic shunt (TCTIPS) creation in patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins. Methods Transcaval TIPS, performed in 65 patients, was indicated by active variceal bleeding (n=52), intractable ascites (n=12), and as a bridge to liver transplantation (n=1). The main reasons for transcaval rather than classic TIPS were the presence of an unusually acute angle between the hepatic veins and the level of the portal bifurcation (n=3), hepatic venous occlusion (n=2), and inadequate small hepatic veins (n=1). Results Technical and functional success was achieved in all patients. The entry site into liver parenchyma from the inferior vena cava was within 2 cm of the atriocaval junction. Conclusion In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is secure and feasible.