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通过静脉输入的肝外移植系统切除 (TEPS):通过血管内超声导向创建波尔托卡瓦尔,中腔卡瓦尔和脊髓切除

Aakash N Gupta¹, John D Louie¹, Daniel Y Sze¹

¹Division of Interventional Radiology, Stanford University, Stanford, CA.

Journal of vascular and interventional radiology : JVIR

|February 19, 2026

概括

血管内超声 (IVUS) 引导的透静脉外肝移植系统分流 (TEPS) 创建是患有门高血压并发症的患者可行的和有效的程序. 这种技术表现出高的技术成功和长期耐用性,提供了一个可行的替代方案,当跨内肝移植系统 (TIPS) 不是一个选择.

科学领域:

干预性放射学干预性放射学
肝病学肝病学是一种肝病学.
血管外科血管外科

背景情况:

门性高血压并发症,如水出血和耐火性,带来了重大管理挑战.
创建跨内肝移植系统分流 (TIPS) 是一种标准治疗方法,但由于解剖学限制或之前的干预措施,对于所有患者来说都是不可行的.
对于那些不适合传统TIPS程序的患者,需要采用替代策略.

研究的目的:

评估血管内超声波 (IVUS) 引导的输血管外肝移植系统分流 (TEPS) 创建的可行性,安全性和长期疗效.
评价TEPS作为门高血压患者不能接受TIPS创建的替代方案.

主要方法:

一项回顾性单一中心研究,涉及23名患者 (24名TEPS手术) 的症状包括水出血,耐火性,以及手术前门口减压.
患者有复杂的静脉解剖学,包括慢性门静脉封闭,上半腹静脉封闭或阻塞的肝内通道.
测量结果包括技术成功,周围手术和延迟不良事件,冲刺通透性和整体存活率.

主要成果:

100%的技术成功率在各种分流配置 (波托卡瓦尔,上半导体,下半导体,鼻) 中实现.
周围过程的不良事件一般是低级的 (38%为1-2级),其中有一例是3级急性损伤 (4%).
观察到优异的长期通透性 (100%在1年和3年) 和持续控制,尽管在17%的患者中出现了复发性水出血,而在36%的患者中发生了肝脏脑病.

结论:

以IVUS引导的TEPS创建是一种可行,安全和有效的治疗方法,用于管理TIPS不适合患者的门高血压并发症.
该程序表现出高度的技术成功和持久的分流通透性,为复杂的案件提供了有价值的替代方案.
长期结果支持TEPS作为一种持久的解决方案,尽管需要仔细监测潜在的并发症,如肝脑病变.

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