中国实用外科杂志

中国实用外科杂志

• 论蓍 • 上一篇    下一篇

脐静脉再通联合一期支架植入法改良Meso-rex手术治疗门静脉海绵样变临床研究

汤    睿1，于里涵1，张    丽1,2[Author]) AND 1[Journal]) AND year[Order])" target="_blank">2，张新静1，贾    凡1,2[Author]) AND 1[Journal]) AND year[Order])" target="_blank">2，李    昂1，董家鸿1，张跃伟1，卢    倩1   

  1. 1北京清华长庚医院肝胆胰中心 清华大学临床医学院，北京102218；2青海大学附属医院肝胆胰外科，青海西宁 810001
  • 出版日期:2019-05-01 发布日期:2019-05-06

  • Online:2019-05-01 Published:2019-05-06

摘要：

目的    研究再通脐静脉联合一期支架植入的方法，改良Meso-rex手术，治疗门静脉海绵样变的效果。方法    回顾性分析2018年2月北京清华长庚医院1例原位经典全肝移植术后9年余，门静脉主干闭塞，继发门静脉海绵样变、门静脉高压、食管胃底静脉曲张、消化道出血的病人资料。对该病人进行Meso-rex手术治疗。楔形切除部分肝脏实质可显露圆韧带根部，门静脉左支难以解剖。再通脐静脉至门静脉左支后，完成血管吻合、支架植入。术后予以抗凝治疗并监测桥血管内血流情况。结果    术程顺利，病人术后1年桥血管血流通畅，未再发生消化道出血症状。结论    脐静脉再通联合一期支架植入法Meso-rex手术可用于治疗门静脉左支通畅但难以解剖显露的门静脉海绵样变病人。远期效果值得期待和更多病例验证。

关键词: 门静脉海绵样变, 门静脉高压, Meso-rex手术, 脐静脉再通, 血管支架

Abstract:

Umbilical vein recanalization with one stage stent placement as modified Meso-rex bypass for portal vein cavernous transformation　　TANG Rui, YU Li-han,ZHANG Li, et al. Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Beijing102218, China
Corresponding author: LU Qian ,E-mail: luqianbtch@163.com
Abstract　Objective　To study the effect of modified meso-rex surgery combined with umbilical vein recanalization and primary stent implantation in the treatment of portal vein portal vein cavernous transformation. Methods　A retrospective study was conducted in Beijing Tsinghua Changgung Hospital. A patient underwent classic or thotopic total liver transplantation for more than 9 years, admitted in February 2018 was selected.Her  main portal vein occlusion and portal vein cavernous transformation were followed by portal hypertension, esophageal and gastric varices, and gastrointestinal bleeding. Surgical treatment of Meso-rex bypass were performed. During operation, hyperplasia of the left liver was noted. After wedge resection of part of the left liver parenchyma, the stump of ligamentum teres hepatis was exposed. Left portal vein was difficult to be dissected and exposed. After the umbilical vein was recanalized to the left branch of the portal vein, vascular anastomosis and stent implantation were completed. Postoperative anticoagulant therapy was given, and the blood flow was monitored. Results　The shunt procedure was successful. The bypass patent, and blood flow was unobstructed 1-year post-operation. No gastrointestinal bleeding occurred ever. Conclusion　Meso-rex bypass combined with umbilical vein recanalization and primary stent implantation can be used to treat patients with portal vein cavernous transformation whose left portal vein is patent but difficult to be exposed.The long-term effect is worth expecting and more cases are needed for further verification.

Key words: portal vein cavernous transformation, portal hypertension, Meso-rex bypass, umbilical vein recanalization, intravascular stent