TIPS经颈内静脉肝内门腔分流术

（优选）TIPS经颈内静脉肝内门腔分流术现在是1页\一共有51页\编辑于星期一

Howisitperformed?ThepatientlaysonhisbackonanX-raytable.Theinternaljugularveinintheneckislocated.Theskiniscleansed,andathinneedleisusedtoinjectalocalanesthetictothepuncturearea.ASeldingerneedleisusedtopassacatheter(overawire)thatismoveddowntotheliver.Aspecialbiopsyneedleisthenusedthroughtheguidingsheathtoobtainthebiopsysample.现在是2页\一共有51页\编辑于星期一WhyTransjugular?Themainadvantageofthetransjugularapproachtoliverbiopsyisthatthelivertissueisobtainedwithinthevascularsystem,therebyminimizingtheriskofbleeding.Remember:Liverdeseaseleadstocoagulationproblems.Thetransjugularapproachismostcommonlyusedforpatientsinwhomapercutaneousapproachisconsideredtobeunsafe.-Coagulopathy-Ascites

现在是3页\一共有51页\编辑于星期一

Firstly,letusknowmuchbasicknowledge!thenyouwouldbeeasyunderstandnextslide.现在是4页\一共有51页\编辑于星期一现在是5页\一共有51页\编辑于星期一

Anatomy现在是6页\一共有51页\编辑于星期一现在是7页\一共有51页\编辑于星期一

PortalVeinSystem现在是8页\一共有51页\编辑于星期一现在是9页\一共有51页\编辑于星期一

AbdominalVenousSystemVenaCava-RenalVeins-IliacVeins-HepaticVein**VenaPorta

-EsophagalVeins-Left&RightGastricVeins-SplenicVein-SuperiorMesentericVein-InferiorMesentericVein现在是10页\一共有51页\编辑于星期一

TheliverandHowitworksItdoeshundredsofvitalthingstomakesureeverythingrunssmoothly:-Storesvitamins,sugarandirontohelpgiveyourbodyenergy.-Controlstheproductionandremovalofcholesterol.-Clearsthebodyofwasteproducts,drugsandotherpoisonoussubstances.现在是11页\一共有51页\编辑于星期一

TheliverandHowitworks-Makesclottingfactorstostopexcessivebleeding.-Producesimmunefactorsandremovesbacteriafromthebloodstreamtocombatinfection.-Releasesasubstancecalled“bile”tohelpdigestfoodandtoabsorbimportantnutrients.现在是12页\一共有51页\编辑于星期一WhatisCirrhosisandPortalHypertension?现在是13页\一共有51页\编辑于星期一

CirrhosisoftheLiver现在是14页\一共有51页\编辑于星期一

CirrhosisoftheLiverWithcirrhosis,thenormallivercellsaredamagedandreplacedbyscartissue.Thisdistortionofthenormalliverstructureinterfereswiththeflowofbloodthroughtheliver.Thebodyrespondsbydivertingthisbloodthroughbloodvesselssurroundingtheupperportionofthestomachandthelowerportionoftheesophagus.现在是15页\一共有51页\编辑于星期一

CirrhosisoftheLiverTheincreasedbloodvolumeintheseveinscausesformationofVarices.Varicesareswollenveinswithaweakenedwall.TheseVaricesoftenruptureunderincreasedpressure,causingmassivebleeding.现在是16页\一共有51页\编辑于星期一

PortalHypertension

Portalhypertensionisanincreasedpressureintheliver’scirculatorysystem,duetoalargebloodpressuredifferencebetweentheportalveinandtheinferiorvenacava.Portalhypertensionismostcommonlycausedbycirrhosis.现在是17页\一共有51页\编辑于星期一现在是18页\一共有51页\编辑于星期一Couldyoutellmeboth2relation?

CirrhosisPortalHypertensionYESorNO现在是19页\一共有51页\编辑于星期一

Howtodealwith?现在是20页\一共有51页\编辑于星期一现在是21页\一共有51页\编辑于星期一现在是22页\一共有51页\编辑于星期一现在是23页\一共有51页\编辑于星期一现在是24页\一共有51页\编辑于星期一现在是25页\一共有51页\编辑于星期一现在是26页\一共有51页\编辑于星期一现在是27页\一共有51页\编辑于星期一现在是28页\一共有51页\编辑于星期一现在是29页\一共有51页\编辑于星期一现在是30页\一共有51页\编辑于星期一现在是31页\一共有51页\编辑于星期一现在是32页\一共有51页\编辑于星期一WhatdoesCookofferfor

PortalHypertension

现在是33页\一共有51页\编辑于星期一现在是34页\一共有51页\编辑于星期一现在是35页\一共有51页\编辑于星期一现在是36页\一共有51页\编辑于星期一现在是37页\一共有51页\编辑于星期一

HowtodotheTIPS?

现在是38页\一共有51页\编辑于星期一现在是39页\一共有51页\编辑于星期一

HowtoTIPS现在是40页\一共有51页\编辑于星期一现在是41页\一共有51页\编辑于星期一TIPSprocedure

AcatheterisplacedintherightjugularVein.Thecatheteristhreadedthroughthesuperiorandinferiorvenacavatothehepaticvein.Thewallofthehepaticveinispuncturedandtheneedleisdirectedtotheportalvein.-Successfulpassageintotheportalveinisdeterminedbyinjectingdyethroughthecatheter.现在是42页\一共有51页\编辑于星期一TIPSprocedure

Aguidewireisthreadedthroughtheneedletomaintainthepassagebetweenthehepaticandportalveins.现在是43页\一共有51页\编辑于星期一TIPSprocedureAballoonisusedacrossthepassagetowidentheholesinthevesselwallsandthepassagethroughthelivertissue.现在是44页\一共有51页\编辑于星期一TIPSprocedure-Astentisthenpositionedalongthepassage,overlappingthelivertissueandextendingintobothveins.Thestentisopenedtoitsmaximumwidthwithballoondilation.Bloodflowfromtheportalveinacrossthestenttothehepaticveinandintothevenacavaisconfirmedbydye