Case Report: Percutaneous Transvenous Coil Embolization of an Extrahepatic Portosystemic Shunt in a Dog

病例報告：以「經皮式血管內線圈放置法」成功治療犬肝外門脈分流

楊淑芳(Shu-Fang Yang) ； 楊姮稜(Heng-Leng Yang) ； 蕭世烜(Shih-Hsuan Hsiao) ； 林平章(Ping-Chang Lin) ； 程秉輝(Bing-Huei Cheing) ； 蔡筱蓓(Hsiao-Pei Tsai) ； 范嘉麟(Chian-Ling Fan) ； 王文亮(Wen-Liang Wang) ； 張志成(Chih-Cheng Chang) ； 梁碩麟(Sao-Liang Liang)

《臺灣獸醫學雜誌》 36卷2期 (2010/06) Pp. 107-114

https://doi.org/10.7009/TVJ.201006.0107

摘要

一隻一歲大6.5公斤未結紮雌性雪那瑞，因為食慾不振、精神萎靡、間斷嘔吐與肝指數上升持續2個月，至嘉義大學農學院附設動物醫院就診。血液檢查發現低白蛋白與肝指數偏高，空腹與飯後血液膽酸指數皆過高；腹腔X光影像發現肝臟偏小，腹腔超音波顯示肝萎縮。電腦斷層掃描確診此犬為肝外門脈分流，分流位置介於脾靜脈和後腔靜脈之間，分流血管長度約2公分，直徑1.5-6.5公厘。選擇以「經皮式血管內線圈放置法」(percutaneous trans-venous coil embolization)治療本患犬。經由頸靜脈放入血管導管，經此導管放置血管內線圈，以C型臂透視X光機定位血管位置，將兩個直徑7公厘之血管內線圈分別放入血管分流處，手術時間約2小時。術後隔日動物無不適症狀，術後2周複診血液指數恢復正常；手術後兩年再以電腦斷層檢查該犬，結果顯示門脈分流血管已完全阻塞，動物狀況良好且血液指數正常。以「經皮式血管內線圈放置法」運用在犬隻肝外門脈分流，不僅侵入性小且術後動物恢復快，是非常值得考慮使用的一種治療方法。

關鍵字

血管內線圈 ； 犬 ； 門脈分流

並列摘要

An 1-year-old, 6.5 kg, intact female Schnauzer was referred to the National Chiayi University Veterinary Teaching Hospital with a history of intermittent anorexia, lethargy, vomiting, and elevated serum liver enzymes for 2 months. Laboratory examinations revealed hypoalbuminemia, elevated alanine aminotransferase and aspartate transaminase. Pre- and post-prandial serum bile acid concentrations were also elevated. Plain abdominal radiographs showed microhepatica. Abdominal ultrasonography showed a small liver with few detectable hepatic or portal veins. Contrast enhanced computed tomography of the liver and portal system angiograms confirmed the presence of an extrahepatic portosystemic shunt. The portocaval shunt vessel was measured approximately 2 cm in length and 1.5-6.5 mm in diameter. Percutaneous transvenous coil embolization (PTCE) was performed using two stainless steel coils with 7-mm in diameter. Two weeks after the PTCE, serum bile acid levels were within normal range. Two years after the PTCE, the patient was clinically normal and contrast enhanced computed tomography angiogram showed a complete occlusion of the shunting vessel. PTCE could be performed more easily and less invasively than surgery in dogs. It is therefore suggested that PTCE is a promising technique in treating canine extrahepatic PSS.

並列關鍵字

coil embolization ； dog ； portosystemic shunts