（優(yōu)選）TIPS經(jīng)頸內(nèi)靜脈肝內(nèi)門腔分流術(shù)現(xiàn)在是1頁\一共有51頁\編輯于星期一

Howisitperformed?ThepatientlaysonhisbackonanX-raytable.Theinternaljugularveinintheneckislocated.Theskiniscleansed,andathinneedleisusedtoinjectalocalanesthetictothepuncturearea.ASeldingerneedleisusedtopassacatheter(overawire)thatismoveddowntotheliver.Aspecialbiopsyneedleisthenusedthroughtheguidingsheathtoobtainthebiopsysample.現(xiàn)在是2頁\一共有51頁\編輯于星期一WhyTransjugular?Themainadvantageofthetransjugularapproachtoliverbiopsyisthatthelivertissueisobtainedwithinthevascularsystem,therebyminimizingtheriskofbleeding.Remember:Liverdeseaseleadstocoagulationproblems.Thetransjugularapproachismostcommonlyusedforpatientsinwhomapercutaneousapproachisconsideredtobeunsafe.-Coagulopathy-Ascites

現(xiàn)在是3頁\一共有51頁\編輯于星期一

Firstly,letusknowmuchbasicknowledge!thenyouwouldbeeasyunderstandnextslide.現(xiàn)在是4頁\一共有51頁\編輯于星期一現(xiàn)在是5頁\一共有51頁\編輯于星期一

Anatomy現(xiàn)在是6頁\一共有51頁\編輯于星期一現(xiàn)在是7頁\一共有51頁\編輯于星期一

PortalVeinSystem現(xiàn)在是8頁\一共有51頁\編輯于星期一現(xiàn)在是9頁\一共有51頁\編輯于星期一

AbdominalVenousSystemVenaCava-RenalVeins-IliacVeins-HepaticVein**VenaPorta

-EsophagalVeins-Left&RightGastricVeins-SplenicVein-SuperiorMesentericVein-InferiorMesentericVein現(xiàn)在是10頁\一共有51頁\編輯于星期一

TheliverandHowitworksItdoeshundredsofvitalthingstomakesureeverythingrunssmoothly:-Storesvitamins,sugarandirontohelpgiveyourbodyenergy.-Controlstheproductionandremovalofcholesterol.-Clearsthebodyofwasteproducts,drugsandotherpoisonoussubstances.現(xiàn)在是11頁\一共有51頁\編輯于星期一

TheliverandHowitworks-Makesclottingfactorstostopexcessivebleeding.-Producesimmunefactorsandremovesbacteriafromthebloodstreamtocombatinfection.-Releasesasubstancecalled“bile”tohelpdigestfoodandtoabsorbimportantnutrients.現(xiàn)在是12頁\一共有51頁\編輯于星期一WhatisCirrhosisandPortalHypertension?現(xiàn)在是13頁\一共有51頁\編輯于星期一

CirrhosisoftheLiver現(xiàn)在是14頁\一共有51頁\編輯于星期一

CirrhosisoftheLiverWithcirrhosis,thenormallivercellsaredamagedandreplacedbyscartissue.Thisdistortionofthenormalliverstructureinterfereswiththeflowofbloodthroughtheliver.Thebodyrespondsbydivertingthisbloodthroughbloodvesselssurroundingtheupperportionofthestomachandthelowerportionoftheesophagus.現(xiàn)在是15頁\一共有51頁\編輯于星期一

CirrhosisoftheLiverTheincreasedbloodvolumeintheseveinscausesformationofVarices.Varicesareswollenveinswithaweakenedwall.TheseVaricesoftenruptureunderincreasedpressure,causingmassivebleeding.現(xiàn)在是16頁\一共有51頁\編輯于星期一

PortalHypertension

Portalhypertensionisanincreasedpressureintheliver’scirculatorysystem,duetoalargebloodpressuredifferencebetweentheportalveinandtheinferiorvenacava.Portalhypertensionismostcommonlycausedbycirrhosis.現(xiàn)在是17頁\一共有51頁\編輯于星期一現(xiàn)在是18頁\一共有51頁\編輯于星期一Couldyoutellmeboth2relation?

CirrhosisPortalHypertensionYESorNO現(xiàn)在是19頁\一共有51頁\編輯于星期一

Howtodealwith?現(xiàn)在是20頁\一共有51頁\編輯于星期一現(xiàn)在是21頁\一共有51頁\編輯于星期一現(xiàn)在是22頁\一共有51頁\編輯于星期一現(xiàn)在是23頁\一共有51頁\編輯于星期一現(xiàn)在是24頁\一共有51頁\編輯于星期一現(xiàn)在是25頁\一共有51頁\編輯于星期一現(xiàn)在是26頁\一共有51頁\編輯于星期一現(xiàn)在是27頁\一共有51頁\編輯于星期一現(xiàn)在是28頁\一共有51頁\編輯于星期一現(xiàn)在是29頁\一共有51頁\編輯于星期一現(xiàn)在是30頁\一共有51頁\編輯于星期一現(xiàn)在是31頁\一共有51頁\編輯于星期一現(xiàn)在是32頁\一共有51頁\編輯于星期一WhatdoesCookofferfor

PortalHypertension

現(xiàn)在是33頁\一共有51頁\編輯于星期一現(xiàn)在是34頁\一共有51頁\編輯于星期一現(xiàn)在是35頁\一共有51頁\編輯于星期一現(xiàn)在是36頁\一共有51頁\編輯于星期一現(xiàn)在是37頁\一共有51頁\編輯于星期一

HowtodotheTIPS?

現(xiàn)在是38頁\一共有51頁\編輯于星期一現(xiàn)在是39頁\一共有51頁\編輯于星期一

HowtoTIPS現(xiàn)在是40頁\一共有51頁\編輯于星期一現(xiàn)在是41頁\一共有51頁\編輯于星期一TIPSprocedure

AcatheterisplacedintherightjugularVein.Thecatheteristhreadedthroughthesuperiorandinferiorvenacavatothehepaticvein.Thewallofthehepaticveinispuncturedandtheneedleisdirectedtotheportalvein.-Successfulpassageintotheportalveinisdeterminedbyinjectingdyethroughthecatheter.現(xiàn)在是42頁\一共有51頁\編輯于星期一TIPSprocedure

Aguidewireisthreadedthroughtheneedletomaintainthepassagebetweenthehepaticandportalveins.現(xiàn)在是43頁\一共有51頁\編輯于星期一TIPSprocedureAballoonisusedacrossthepassagetowidentheholesinthevesselwallsandthepassagethroughthelivertissue.現(xiàn)在是44頁\一共有51頁\編輯于星期一TIPSprocedure-Astentisthenpositionedalongthepassage,overlappingthelivertissueandextendingintobothveins.Thestentisopenedtoitsmaximumwidthwithballoondilation.Bloodflowfromtheportalveinacrossthestenttothehepaticveinandintothevenacavaisconfirmedbydye