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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2018, Vol. 07 ›› Issue (02) : 133 -137. doi: 10.3877/cma.j.issn.2095-3232.2018.02.012

所属专题： 文献；

临床研究

髂动脉搭桥Meso-Rex术治疗原发性门静脉海绵样变性
沙地克·阿帕尔1, 吐尔洪江·吐逊1, 姚刚1, 江多斯·帕依孜吾拉1, 张皓1, 赵晋明1, 李涛1,†()   
  1. 1. 830054　乌鲁木齐，新疆医科大学第一附属医院消化血管外科中心肝（移植）·腹腔镜外科
  • 收稿日期:2017-12-29 出版日期:2018-04-10
  • 通信作者: 李涛
  • 基金资助:
    国家自然科学基金(81560329)

Meso-Rex bypass using iliac arterial for primary cavernous transformation of portal vein

Apaer Shadike1, Tuxun Tuerhongjiang1, Gang Yao1, Payiziwula Jiangduosi1, Hao Zhang1, Jinming Zhao1, Tao Li1,†()   

  1. 1. Department of Liver Transplantation & Laparoscopic Surgery, Digestive & Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
  • Received:2017-12-29 Published:2018-04-10
  • Corresponding author: Tao Li
  • About author:
    Corresponding author: Li Tao, Email:
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引用本文：

沙地克·阿帕尔, 吐尔洪江·吐逊, 姚刚, 江多斯·帕依孜吾拉, 张皓, 赵晋明, 李涛. 髂动脉搭桥Meso-Rex术治疗原发性门静脉海绵样变性[J]. 中华肝脏外科手术学电子杂志, 2018, 07(02): 133-137.

Apaer Shadike, Tuxun Tuerhongjiang, Gang Yao, Payiziwula Jiangduosi, Hao Zhang, Jinming Zhao, Tao Li. Meso-Rex bypass using iliac arterial for primary cavernous transformation of portal vein[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(02): 133-137.

目的

探讨采用髂动脉搭桥肠系膜上静脉-肝内门静脉左支分流术（Meso-Rex）治疗原发性门静脉海绵样变性（CTPV）的可行性。

方法

患者女，40岁，因"上腹部隐痛不适4周"入院。腹部CT血管造影示CTPV，食管下端、胃底静脉曲张，脾大。入院诊断：原发性CTPV。应用心脏死亡器官捐献来源的髂动脉在肠系膜上静脉和肝内门静脉左支间搭桥行Meso-Rex术。术后采用肝素钠抗凝治疗，超声检查随访。患者签署知情同意书，符合医学伦理学规定。

结果

患者手术顺利，术后复查搭桥血管血流通畅，未出现并发症。患者随访3个月，搭桥血管无血栓形成。

结论

Meso-Rex术是CTPV的治愈性术式，其临床疗效确切。髂动脉作为分流血管是安全可行的。术后积极抗凝治疗，预防血栓形成是手术成功的关键。

关键词: 门静脉海绵样变性, 高血压，门静脉, Meso-Rex, 髂动脉
Objective

To explore the feasibility of superior mesenteric vein-left portal vein bypass (Meso-Rex) using iliac arterial in the treatment of primary cavernous transformation of portal vein (CTPV).

Methods

The patient, female, 40 years old, was hospitalized due to dull pain in the upper abdomen for4 weeks. Abdominal CT angiography showed CTPV, varicosity in the lower esophagus and fundus of stomach, and splenauxe. The admitting diagnosis was primary CTPV. Meso-Rex was performed using iliac artery from donation after cardiac death bridging between superior mesenteric vein and left intrahepatic portal vein. The patient was given heparin for anticoagulation therapy and was followed up by ultrasound after the operation. The informed consent of this patient were obtained and the local ethical committee approval was received.

Results

The operation was performed successfully. The blood flow of bypass vessel was good after operation, and no complication was observed. During 3 months follow-up, no thrombosis in the bypass blood vessel was observed.

Conclusion

Meso-Rex is a curative operation for CTPV, and has definite clinical effect. Iliac artery is safe and feasible when used as a shunt vessel. Giving active anticoagulant therapy to prevent thrombosis after operation is the key to success.

Key words: Cavernous transformation of portal vein, Hypertension, portal, Meso-Rex, Iliac artery
图1 门静脉海绵样变性患者腹部CT血管造影图像
图2 门静脉海绵样变性患者Meso-Rex术中图像
图3 门静脉海绵样变性患者Meso-Rex术后彩超检查图像
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