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1.
目的 探讨内支架治疗技术在肝移植术后门静脉狭窄治疗中的应用价值.方法 回顾性分析肝移植术后发生门静脉狭窄的7例患者资料,所有患者均采用内支架置入治疗,对患者临床资料、影像随访资料、介入治疗的并发症和预后等情况进行总结.结果 7例均成功置入门静脉内支架,所有患者术后均无与门静脉治疗相关的并发症发生.患者随访3~34个月.除1例因同时合并肝动脉闭塞、缺血性胆道损伤于术后3个月死于多脏器功能衰竭,其余6例患者影像随访显示门静脉通畅.结论 肝移植术后门静脉狭窄的介入内支架治疗是一种安全、有效的治疗方法. 相似文献
2.
Two liver transplant patients with hepatopetal collaterals after portal vein thrombosis are described. Angiographically, the
appearance is similar to cavernous transformation of the portal vein. The demonstration of hepatopetal collaterals is diagnosic
of portal vein occlusion from whatever cause. After portal vein occlusion, collaterals develop from preexisting periportal
vessels which undergo compensatory enlargement and reconstitute the intraheptic portal vessels. In liver transplant patients,
the collateral communications must arise de novo, since all potential collateral pathways are severed at the time of transplantation. 相似文献
3.
Jose Ignacio Bilbao Mercedes Arias Jose Ignacio Herrero Alfonso Iglesias Fernando Martínez Regueira Pedro Luis Alejandre Jesus María Longo Jorge Quiroga 《Cardiovascular and interventional radiology》1995,18(5):323-326
Percutaneous transhepatic treatment of portal vein thrombosis after liver transplantation in a patient with a preexisting high volume spontaneous splenorenal shunt is presented. Local thrombolysis with urokinase and balloon angioplasty of the main portal vein stenosis were performed followed by shunt embolization to restore hepatopetal portal blood flow. 相似文献
4.
5.
The role of radiology in the diagnosis and treatment of biliary complications after liver transplantation 总被引:4,自引:0,他引:4
Janis Gissel Letourneau M.D. Wilfrido R. Castañeda-Zuñiga 《Cardiovascular and interventional radiology》1990,13(4):278-282
Hepatic transplantation is now an accepted therapeutic option for selected patients with terminal liver disease. Biliary complications
are, however relatively common after transplantation. We reviewed our experience with diagnostic and therapeutic biliary radiologic
procedures in 151 hepatic recipients. Biliary complications were seen in 25% of patients. Interventional radiologic procedures
were an integral part of the diagnostic and therapeutic management of these patients; reoperation was, nonetheless, occasionally
required. 相似文献
6.
Percutaneous transhepatic angioplasty and stent implantation for prehepatic portal vein obstruction 总被引:1,自引:0,他引:1
Prof. Dr. Klaus Mathias Ullrich Bolder Dietrich Löhlein Horst Jäger 《Cardiovascular and interventional radiology》1993,16(5):313-315
Twenty-nine months after a Whipple procedure for pancreatic carcinoma, a 47-year-old woman developed esophageal variceal bleeding.
Percutaneous transhepatic portography revealed a severe stenosis of the portal vein with prehepatic portal hypertension and
collateral circulation mainly to the gastric and esophageal veins. Percutaneous transhepatic balloon angioplasty was used
to dilate the stenoses, but it did not remove the stenosis sufficiently. Therefore, an 8-mm, self-expandable stent was implanted,
creating a nearly normal lumen without a pressure gradient. Portal hypertension was relieved, and the patient had no recurrent
variceal bleeding for the 5 months up to her death. 相似文献
7.
Objective
To compare the efficacy of suprapapillary and transpapillary methods of transhepatic biliary metallic stent placement in malignant biliary strictures and to specify the indications of each method applied.Materials and Methods
Stents were placed in 59 patients. Strictures were categorized as type A (within 3 cm of the ampulla, n = 27), type B (over 3 cm from ampulla, n = 7), type C (within 3 cm of the bending portion, n = 9), or type D (over 3 cm above the bending portion, n=16). The stenting method was suprapapillary in 34 cases and transpapillary in 25. The rates of initial and long-term patency and of early recurrence were compared.Results
Initial patency rates for the suprapapillary and transpapillary methods were 1/7 (14.3%) and 20/20 (100%) respectively for type A (p < 0.0001), 4/5 (80.0%) and 2/2 for type B, 3/7 (42.9%) and 2/2 for type C, and 15/16 (93.8%) and 0/0 for type D. Early recurrence rates were 7/30 (23.3%) using the suprapapillary method and 4/29 (13.8%) using the transpapillary method (p = 0.51). The long-term patency rate did not differ significantly according to either type (p = 0.37) or method (p = 0.62).Conclusion
For good initial patency, the transpapillary method is recommended for strictures of the distal extrahepatic duct near the ampulla and just above the bending portion. Long-term patency is not influenced by the stenting method employed. 相似文献8.
P. Legmann Y. Martin Bouyer O. Tudoret O. Limot Y. Calmus D. Houssin A. Bonnin 《European radiology》1993,3(4):371-375
We used transhepatic percutaneous transluminal angioplasty to treat two patients who developed a severe anastomic portal vein stricture 7 months and 4 years respectively after liver transplantation. All signs of portal hypertension (pressure gradient, massive venous collateral circulation) disappeared following the procedure and remained absent 12 months later. Our results suggest that percutaneous transhepatic angioplasty should be considered for treatment of liver transplant recipients with anastomotic portal vein strictures.
Correspondence to: P. Legmann 相似文献
9.
Percutaneous transhepatic catheterization of the portal vein: A combined CT- and fluoroscopy-guided technique 总被引:3,自引:0,他引:3
Bernd Weimar M.D. Klaus Rauber Mathias D. Brendel Reinhard G. Bretzel Wigbert S. Rau 《Cardiovascular and interventional radiology》1999,22(4):342-344
Combined CT- and fluoroscopy-guided transhepatic portal vein catheterization was performed in 44 patients selected for pancreatic
islet cell transplantation. The method allowed catheterization with a single puncture attempt in 39 patients. In four patients
two attempts and in one patient four attempts were necessary. One minor hematoma of the liver capsule occurred that required
no further treatment. Compared with other methods the average number of puncture attempts was reduced. 相似文献
10.
Maleux G Vaninbroukx J Verslype C Vanbeckevoort D Van Hootegem P Nevens F 《Cardiovascular and interventional radiology》2003,26(4):395-397
One month after onset of an acute biliary
pancreatitis, a 75-year-old man developed refractory ascites. Duplex
ultrasound and CT scan revealed a focal stenosis of the extrahepatic
portal vein as confirmed by transhepatic direct portography. In the
same session, this stenosis, responsible for symptomatic prehepatic
portal hypertension, was successfully dilated and stented and
afterwards a residual pressure gradient of 1 mmHg over the stented
segment was measured. One week after the stenting procedure the patient
was free of ascites and control physical and biochemical examination
one year later is completely normal. 相似文献
11.
Christoph D. Becker Franz Eigenmann Ulrich Scheurer Fred Halter 《Cardiovascular and interventional radiology》1993,16(3):144-149
Forty-one patients underwent nonsurgical removal of postoperatively retained bile duct stones in two nonrandomized groups.
The endoscopic-retrograde technique was used in 21 patients, and succeeded in 19. The percutaneous approach through the T-tube
tract was used in 22 patients, including the two in whom endoscopic stone removal had failed, and was successful in 21 patients.
Individual preferences and prior history introduced a selection bias against the percutaneous technique. Auxiliary extracorporeal
shockwave lithotripsy (ESWL) was used in 2 patients whose stones could not be fragmented mechanically by the percutaneous
basket technique. ESWL was successful in one patient but failed in the second. Because endoscopy had also failed in this case,
the patient subsequently underwent repeat surgery. Procedure-related complications were minor with both techniques and were
readily treated by conservative measures. We conclude that both the retrograde and the percutaneous approaches are effective
and safe. The endoscopic approach appears convenient because there is no need to await maturation of the percutaneous tract,
but sphincterotomy carries a small but distinctive risk. Because the percutaneous approach uses an existing tract, is only
minimally invasive and leaves the sphincter of Oddi intact, it is preferable in those patients who have T-tubes of approapriate
size and position in place. 相似文献
12.
Alfidja A Abergel A Chabrot P Pezet D Bony C Ravel A Garcier JM Roche A Boyer L 《Acta radiologica (Stockholm, Sweden : 1987)》2006,47(2):130-134
We report two cases of percutaneous transhepatic stenting of the portal vein to treat stenosis and occlusion disclosed 5 and 18 months, respectively, after orthotopic liver transplantation in two adult patients. If long-term patency is satisfactory, this technique should allow long-term management of portal vein stenosis and occlusion without the use of thrombolysis. 相似文献
13.
Percutaneous biliary drainage and stenting (PTBD) for palliation of malignant obstructive jaundice has evolved to a safe and
effective technique. PTBD is equally effective for treatment of distal and proximal bile obstruction. Metal self-expandable
stents have proved superior to plastic stents and should therefore be used. Technical success is >90% en clinical success
is >75% in all major series. There are a considerable number of complications, but most can be treated conservatively and
procedure-related mortality is <2% in most series. Thirty-day mortality after PTBD is >10% in many series, but this is largely
due to the underlying disease. About 10–30% of patients will have recurrent jaundice at some point in their disease after
PTBD and require re-intervention. 相似文献
14.
Portal vein stenosis in a "split-liver" transplant patient is demonstrated on colour Doppler ultrasound and indirect portography with raised splenic pulp pressures which resolves over a 21-month period without surgical or radiological intervention. When a portal vein stenosis in a liver transplant is encountered without severe derangement of liver function tests or signs of portal hypertension, regular follow-up colour Doppler ultrasound surveillance allows for evidence of spontaneous resolution. 相似文献
15.
Stephan H. Duda Peter E. Huppert Ulrich Schott Hans-J. Brambs Claus D. Claussen 《Cardiovascular and interventional radiology》1997,20(2):133-138
Purpose To assess the value of intraductal ultrasound (US) for lymph node staging in malignant biliary obstruction.
Methods Eighteen patients with malignant extrahepatic obstruction were imaged during percutaneous bile duct drainage with a mechanically
rotating US transducer at 12.5 MHz. Detectable lymph nodes were classified as malignant when two of three criteria (hypoechoic,
rounded, conspicuous margins) were fulfilled. The results were compared with histopathological data in 8 patients and follow-up
CT findings in 10 patients.
Results In 15 of 18 patients (83%) malignant lymph node involvement was suspected at intraductal US and in 5 of 18 patients (28%)
during CT. Histopathological investigation after operation (n=8) and follow-up CT studies (n=10) revealed the presence of malignant nodal involvement in 13 of 18 (72%) patients. The sensitivity, specificity, and accuracy
of transhepatic intraductal biliary US in determining merely the presence or absence of malignant lymph nodes without specific
topographic assignment were 92%, 40%, and 78%, respectively.
Conclusion These preliminary results suggest that intraductal US may develop into a promising adjunctive modality during percutaneous
bile duct drainage in patients with suspected malignant regional lymph node involvement. 相似文献
16.
A preoperatively undetected spontaneous mesocaval shunt lead to impairment of organ function after liver transplantation. Ischemia of the graft due to partial hepatofugal portal flow was demonstrated by color-flow Doppler sonography and angiography. The successful catheter embolization of the mesocaval shunt via a transhepatic approach is presented.
Correspondence to: H. Berger 相似文献
17.
Gregory S. Foster Myra I. Rapoport Howard N. Sankary Esther Brown Preston Foster 《European radiology》1992,2(4):346-349
Early detection of hepatic allograft injury is essential to ensure graft viability and to minimize patient morbidity. The hepatic microvasculature is adversely affected in ischemic preservation injury and rejection, resulting in diminished sinusoidal blood flow. We investigated whether portal vein volume flow as determined by Doppler ultrasound could provide an index of graft function. In an animal model for ischemic preservation injury we found significantly reduced portal flow in animals with allograft injury. No significant difference in flow volume was demonstrated between normally functioning allografts and non-operated controls. We have evaluated 42 human patients with hepatic allografts. In patients with normally functioning livers (n = 17), mean portal vein flow (Q) was 1659 ± 524 ml/min. Patients with chronic rejection (n = 3) demonstrated markedly reduced flow (Q = 788 ± 109 ml/min; p < 0.001), similar to that seen in cirrhotic patients undergoing preoperative evaluation for liver transplantation (Q = 668 ± 256 ml/min). Patients with acute rejection demonstrated a wide variance in flow rates. Portal flow volumes < 1050 ml/min were associated with greater long term morbidity than those with greater flow volume. Quantitative doppler flowmetry of the portal vein is a promising new non-invasive technique which may provide a unique physiologic indicator of allograft perfusion.
Correspondence to: G. S. Foster 相似文献
18.
Portal biliopathy (PB) refers to biliary obstruction caused by cavernous transformation of the portal vein (CTPV). CTPV occurs most frequently in patients with liver cirrhosis or malignancy. Less common causes include congenital malformations and neonatal umbilical vein cannulation. We present a case of portal biliopathy in a 28-year-old man with CTPV secondary to umbilical vein catheterization in neonatal age. The case illustrates portal biliopathy as a late complication of neonatal invasive procedures and highlights the importance of a multimodality imaging approach to achieve a prompt diagnosis. 相似文献
19.
目的 回顾性分析肝细胞肝癌伴门静脉主干癌栓(MPWIT)患者经门静脉支架置入及经导管化疗栓塞治疗后序贯门静脉适形放疗的效果.方法 45例肝癌合并MPVTY的患者行经皮门静脉支架置入,支架置入后即刻行经导管动脉内化疗栓塞.其中16例于2~3周后行门静脉适形放疗(A组),29例未行放射治疗(B组).采用Kaplan-Meier生存分析、log-rank检验评价两组间支架通畅率、累积生存率的差异;Fisher精确概率法对比分析两组间肿瘤及癌栓缓解率的差别.结果 本组支架放置过程中及置入后24 h内无患者死亡,无大出血及急性肝功能衰竭等严重并发症.支架置入后2周内所有支架通畅,术后60、180、360 d支架累积通畅率:A组分别为100.0%.62.2%、34.6%,B组分别为58.6%、21.7%、10.8%;累积生存率:A组分别为93.8%、81.3%、32.5%,B组分别为86.2%、13.8%、6.9%,两组相比差异均有统计学意义(X2值分别为9.672、14.596,P值均<0.01).支架平均通畅时间A组为(475±137)d,B组为(200±61)d,两组相比差异有统计学意义(X2=9.672,P<0.01).结论 经导管化疗栓塞联合门静脉支架置人后序贯门静脉适形放疗可提高肝细胞肝癌伴MPVTT患者支架通畅率和生存期. 相似文献
20.
Ze-Zhou Song Tian-An Jiang Qi-Yu Zhao Yun Mou Jian-Yang Ao Yan Chen 《European journal of radiology》2010,75(2):185-188