- 期刊
提供TIPS術前穿刺路徑以減少貫通肝靜脈與門靜脈時造成的併發症
Ecreasing Vascular Injury from TIPS by Pre-Procedure Route Planning
摘要
門靜脈高壓併發之胃食道靜脈曲張出血是肝硬化病人最常見且最危險的併發症，尤其是當內視鏡或外科療法失敗或有高危險性時，經頸靜脈肝內門脈系統分流術(TIPS)是控制出血的有效方法﹝3﹞。執行經頸靜脈肝內門脈系統分流術(TIPS)時，貫通肝靜脈與門靜脈時，容易造成肝動脈、門靜脈、膽道系統及肝臟組織之穿刺傷併發症，造成出血更嚴重及延長檢查時間。於經頸靜脈肝內門脈系統分流術(TIPS)前，執行電腦斷層，以此影像來估算肝靜脈穿刺至門靜脈之距離與方向，繪製成方格圖提供給放射科醫師(TIPS)術前參考。希望行(TIPS)前放射師提供訊息給放射科醫師，縮短放射科醫師貫通肝靜脈與門靜脈時間，降低肝動脈、門靜脈、膽道系統及肝臟組織之穿刺傷，以提高治療的成功率且減少病人併發症的風險。從2006年1月至2008年9月止，共執行了22位(TIPS)的治療病例，男性20人，女性2人；(TIPS)術前使用路徑評估圖8人(36.4%)；未使用路徑評估圖14人(63.6%)。使用路徑評估圖組(path)有1人發生合併症；未使用路徑評估圖組(non-path)有4人發生合併症，統計顯示path組合併症發生率低於non-path組。分析兩組執行TIPS所耗發的時間可知path組所耗費的時間比non-path組少，對執行(TIPS)人員進行路徑評估圖使用滿意度調查結果顯示整體滿意度達80.56%。
並列摘要
Bleeding from portal venous hypertension-related gastric varices or esophageal varices is the commonest and most lethal complication of liver cirrhosis. When the bleeding is failed to be controlled endoscopically or surgically, TIPS may be an effective alternative. TIPS basically represents a pathway created between the hepatic venous and portal venous system. During the process of creating this pathway, the hepatic arteries, portal veins, bile ducts and hepatic parenchyma may be lacerated. These complications not only prolong the procedure time but also worsen the hemorrhage. Method: Abdominal CT is performed prior to commencement of TIPS. Based on the information obtained from CT, radiologists are able to estimate the direction and distance of portal vein from hepatic vein in advance. By providing useful CT information to radiologists prior to commencement of TIPS, hopefully radiographers can help to shorten the procedural time and to decrease procedure-related trauma, in order to increase success rate and to decrease complication rate. Twenty two patients (twenty males and two females) received TIPS from Jan 2006 to Sept 2008. Eight patients (36.4%) had CT planning prior to the procedure while fourteen patients (63.6%) did not. Four patients from the non-CT-planned group had complications while only one patient from the CT-planned group developed complications, suggesting CT was helpful in reducing complication rate. After surveying the staff who were involved in the TIPS procedure, CT-planned TIPS was deemed more time efficient, with an overall satisfaction score of 80.56%.