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超声内镜引导下门静脉定位辅助经颈静脉肝外门体分流术治疗门静脉海绵样变性1例报告
DOI: 10.12449/JCH260521
伦理学声明：本例报告已获得患者及家属知情同意。
利益冲突声明：本文不存在任何利益冲突。
作者贡献声明：杨素珍和诸葛宇征负责课题设计，资料分析，撰写论文；吕瑛参与手术操作，收集数据，修改论文；王雷和张峰负责手术操作，拟定写作思路，指导撰写文章并最后定稿。
Transjugular extrahepatic portosystemic shunt assisted by endoscopic ultrasound-guided portal vein localization in treatment of cavernous transformation of the portal vein： A case report
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摘要: 门静脉海绵样变性（CTPV）是临床治疗的难点之一。近年来，经颈静脉肝内门体分流术逐渐应用于CTPV患者的治疗，但其技术成功率较低、手术风险较高。为提高成功率及安全性，国内外学者已尝试多种改良门体分流术。然而，对于门静脉主干广泛闭塞的CTPV患者，手术难度仍然很大，需制定个体化门体分流策略。本文介绍1例超声内镜引导下门静脉定位辅助颈静脉肝外门体分流术的治疗案例，旨在为CTPV患者的临床处理提供一种新的探索路径。
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关键词:
- 门静脉 /
- 经颈静脉肝外门体分流术 /
- 超声内镜
Abstract: Cavernous transformation of the portal vein （CTPV） is a significant challenge in clinical practice. In recent years， transjugular intrahepatic portosystemic shunt has gradually been applied in the treatment of CTPV patients， but it had a technical success rate and a relatively high surgical risk. The scholars have adopted various modified techniques of portosystemic shunt to improve success rate and safety. However， for CTPV patients with extensive occlusion of the main portal vein， this surgery remains difficult， and individualized strategies for portosystemic shunt should be formulated. This article reports a case of CTPV treated by transjugular extrahepatic portosystemic shunt assisted by endoscopic ultrasound-guided portal vein localization， in order to explore a new pathway for the clinical management of patients with CTPV. -
注： a、b，门静脉左右支栓子形成；c，肝门静脉海绵样变性；d、e，门静脉主干血栓伴栓塞；f，肠系膜上静脉血栓形成。CT，计算机体层扫描。
图 1 患者术前腹部增强CT
Figure 1. Preoperative contrast-enhanced abdominal CT scan
注： a，食管静脉曲张；b，胃底无静脉曲张。
图 2 患者术前胃镜检查
Figure 2. Preoperative esophagogastroduodenoscopy image
注： a，EUS见门静脉血栓；b，22G穿刺针穿刺门静脉汇合区；c，置入弹簧圈。EUS，超声内镜。
图 3 EUS引导下门静脉定位
Figure 3. Endoscopic ultrasound-guided portal vein localization
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