Percutaneous Transhepatic Portography and Embolization

經皮穿肝門靜脈攝影與栓塞法

黃華思(Hua-Szu Hwang)；邱昭彥(Chao-Yen Chiou)；蔡建中(Chien-Chung Tsai)；柯貴榮(Qui-Yong Kuo)；黃明和(Min-Huo Hwang)楊志宗(Jyh-Chung Yang)

門脈攝影 ； 靜脈曲張 ； portography ； varices

中華放射線醫學雜誌

16卷4期（1991 / 12 / 01）

335 - 343

英文

雖然門靜脈X-光攝影術(Portography)，可由腹動脈(Celiac artery)，上腸系膜動脈(Superior mesenteric artery)和脾門靜脈攝影術(Spleno-portography)，獲得影像，但都不能比經皮穿肝門靜脈攝影來得直接、明顯看到胃食道靜脈曲張的血管分佈及其灌注情形。甚至可由此法施行經皮穿肝栓塞法[Percutaneous transhepatic embolization (PTE)]以往胃食道靜脈曲張出血都以內科療法為先，如：1. Vasoactive drugs 2. Balloon tamponade 3. Endoscopic sclerotherapy當內科療效失敗時進以外科的1. Portal-caval shunts 2. Esophageal transaction 3. Devascularization procedure但內科治療無效而病人情況又處於Active bleeding & shock時且又不適合外科手術情形，此時PTP+PTE被視為一有效且安全應用在急診胃食道靜脈曲張出血的治療方法之一。彰化秀傳紀念醫院自1987年11月至1991年5月共有16例病患實施經皮穿肝門靜脈攝影術(Percutaneous transhepatic portography)有一例是實施經脾門靜脈攝影術(Splenoportography)，是因為門靜脈栓塞。15例PTP當中有一例因為左胃靜脈[left gastric vein (LGV)]栓塞，而沒有實施經皮穿肝栓塞(PTE)。在14個病例中作PTE其栓塞物為steel coil, 100%酒精，gelfoam cubes & Sotradecol都能完成栓塞，沒有嚴重的併發症。栓塞後再出血：一週內有20%六個月內再出血約57%（平均為三個月）。有5個進一步開刀，其中3個未再出血另2個sepsis而死亡。有一例先施行IMV-IVC Shunt後再做PTE後亦不再出血。另八例再出血時合用硬化治療後均可控制再出血，其中一例PTE後一個月再出血，5個月後死於liver failure。其中七例至目前還存活著。

Percutaneous transhepatic portography (PTP) was used to visualize veins feeding the bleeding varices in fifteen cases at Show Chwan Memorial Hospital. Splenoportography was performed in one case after unsuccessful attempt of PTP. Percutaneous transhepatic embolization (PTE) was successful in all cases attempted with minimal complications. Rebleeding within 1 week occured in 14% of cases with post-embolization, while in 57%, bleeding recurred on the average of about three months later. Permanent embolic materials were used in all cases for embolization. PTE is a safe emergency treatment for bleeding varices. The high recurrent rate negates the use of this procedure for preventive purpose. Therefore, successful embolization should be followed either by sclerotherapy or by shunt surgery.