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肝硬化门静脉高压介入治疗经验与技巧

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肝硬化门静脉高压介入治疗经验与技巧

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《肝硬化门静脉高压介入治疗经验与技巧》以结合病例的形式详细而生动的讲解了肝硬化门脉高压介入治疗的宝贵经验和技术要点,为广大从事介入专业的医师们提供充足的诊治经验,使类似或相同的患者得到及时、有效的诊治。与目前市场同类书相比,该书以图文并茂的形式,结合病例分析,更加生动易懂,别具一格。
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刘福全,首都医科大学附属北京世纪坛医院、首都医科大学肿瘤医学院介入治疗科(血管病与肿瘤介入治疗科)主任、科研处处长、主任医师、教授,北京大学及首都医科大学研究生导师,首都医科大学肿瘤学系委员、介入学组组长。目前担任多个学术团体及杂志的委员、副主任委员、编委、常务编委及审稿专家等。担任多个国家级及省部级科研立项的评审专家、国家及北京市医疗事故鉴定专家。从事介入医学专业28年,是国内最早应用和熟练掌握介入技术及介入医学科学知识诊治血管病与肿瘤的专家之一。1998年在德国深造,学习血管病与肿瘤介入治疗技术及介入医学知识。是最早组织成立独立的介入治疗专业和科室(包括病房、门诊、手术室及研究室)的专家及科主任之一,使其及相关医生真正成为医学影像与临床专业紧密及有机结合的典范。已完成介入诊疗手术20000余例次,总体介入技术处于国内先进水平,部分技术处于国内领先水平,特别是对肝硬化门静脉高压的诊治有独到的研究,如国内最早应用经皮肝穿胃冠状静脉栓塞术治疗食管胃底静脉曲张出血、对国内最大及随访时间最长的一组TIPs病例进行了系统分析和总结、分流通道获取肝组织、建立肝硬化门静脉高压标本库、建立第二分流通道、门静脉血栓的特殊介入处理及应用介入技术建立大动物肝硬化门静脉模型等。发表论文100余篇,参编著作4部,以第一负责人获得国家级科技支撑计划资助1项、省部级科研基金资助8项、其他资助项目8项,获省部级科技进步奖二等奖1项及三等奖2项,开展介入诊疗新技术60余项,获得两项国家专利,主办及承办国家级继续医学教育项目多项。曾被授予中央国家机关优秀青年,铁道部建功立业奖章获得者,铁道部青年科技拔尖人才和优秀学科带头人等称号。

李捍卫,中国人民解放军第三○二医院肝硬化诊疗中心主任、主任医师,教授,中国人民解放军医学院硕士研究生导师、国家干细胞与再生医学产业技术创新战略联盟理事、全军微血管委员会委员、中华医学会医学工程学分会干细胞工程专业委员会青年委员。长期从事临床一线工作,2001年担任解放军第三。二医院重型肝炎科副主任,对重型肝炎救治及转归积累了丰富经验。2005年,在肝病研究和治疗基础上创建国内第一个移植内科,开展了肝移植后各种并发症预防和诊治,特别是对丙肝相关性肝移植后抗病毒治疗及乙肝相关性肝移植后乙肝复发规律进行了系统研究和临床诊治,大大提高了肝移植患者的生活质量和长期生存率。2009年在全军率先进行了自体骨髓干细胞移植治疗慢性肝病的临床研究,取得了满意临床疗效,为今后干细胞在肝病方面应用开辟了新途径。2010年成立解放军第三○二医院肝硬化诊疗中心并担任中心主任,每年集中收治各种肝硬化患者1800例,系统地开展了肝硬化及其并发症的救治、失代偿肝硬化患者残余肝脏功能提升以及肝硬化后肝癌预防等研究,取得了丰硕成果,特别是对肝硬化后上消化道出血急诊内镜下止血及Ⅰ、Ⅱ级择期的预防取得了满意疗效,对门静脉高压症非常见侧支循环开展了临床研究,为疑难肝硬化门静脉高压症上消化道出血镜下、介入及手术治疗提供可靠依据。先后承担军队“十一五”课题“乙肝相关性肝移植后乙肝复发实验与临床研究”、“十二五”课题“自体骨髓干细胞在终末期肝病中应用”,先后获得军队科技进步二、三等奖,医疗成果三等奖,发表论文60余篇,参编著作4部。

李志伟,主任医师。中国人民解放军第三。二医院肝胆外科一中心主任,全军门静脉高压专业委员会副主任委员,全军普通外科专业委员会委员,全军肝胆外科专业委员会委员。从事肝胆外科临床工作23年,主攻肝硬化门静脉高压引起上消化道出血的外科治疗,近10年完成全脾切除、部分脾切除、断流、脾肾分流、肠腔分流等各种门静脉高压手术2000余例,为国内治疗脾脏肿大、消化道出血手术最多的医师,手术熟练、效果好、并发症少,得到广大患者及同行的充分认可。另外,对肝硬化基础上合并肝癌、肝血管瘤、多囊肝及各种梗阻性黄疸的手术治疗积累了丰富的临床经验。发表有关门静脉高压症、肝癌及肝脏移植论文50余篇,副主编《漫谈门静脉高压症》,参编《漫谈肝脏移植》、《战胜肝脏肿瘤》、《现代传染病学》。主持国家级及省部级课题各1项:“癌症组织中oct4B的表达研究及其功能探究”及“HBv感染肝硬化患者脾脏切除术后免疫学指标的变化及其与患者临床预后的相关性研究”,负责局级课题1项:“脾脏切除贲门周围血管离断术治疗门静脉高压症疗效观察”。另外参与国家级课题3项、省部级3项及局级1项。获得局级科技进步二等奖1项。获得多次优秀论文奖。曾获总后三等功及先进个人的荣誉称号。
Catalogue

第一章 总论
第一节 概述
第二节 肝脏血管解剖
第三节 肝硬化门静脉高压内科治疗
第四节 肝硬化门静脉高压外科治疗
第五节 肝硬化门静脉高压介入治疗基本技术与方法

第二章 肝硬化门静脉高压的介入治疗进展

第三章 巴德-吉亚利综合征
病例1:肝静脉完全闭塞——DIPS术
病例2:肝静脉长段闭塞——经股静脉逆行支架成形术
病例3:肝静脉完全闭塞——右心房-肠系膜上静脉转流术+DIPS术
病例4:肝静脉完全闭塞——侧支血管(第三肝门)支架成形术
病例5:下腔静脉和肝静脉闭塞合并下腔静脉血栓——经皮肝穿门静脉技术+DIPS术+腔静脉支架成形术
病例6:肝静脉闭塞和下腔静脉完全闭塞血栓形成——局部溶栓+腔静脉成形术
病例7:肝静脉及下腔静脉进展性血栓形成及顽固性腹水——TIPS术+腔静脉成形术
病例8:肝静脉完全闭塞——经皮肝穿刺寻找肝静脉技术+DIPS术
病例9:肝静脉急性完全闭塞——DIPS术
病例10:腔静脉与肝静脉联合闭塞——腔静脉支架成形术+肝静脉支架成形术

第四章 肝小静脉闭塞症
病例11:肝小静脉闭塞症+腔静脉型巴德-吉亚利综合征+肝动脉-门静脉瘘——经肝动脉瘘栓塞+腔静脉成形+TIPs术
病例12:TIPs术+获取肝组织
病例13:肝豆状核变性——TIPS术

第五章 门静脉系统血栓
病例14:脾切除术后门静脉完全血栓形成并肠系膜上静脉主干血栓——经皮肝穿取栓及碎栓术+TIPS术+穿刺通道射频消融术
病例15:脾切除术后门静脉部分血栓形成——直接TIPS术+获取肝组织
病例16:脾切除术后门静脉及肠系膜上静脉血栓形成——经皮肝穿门静脉局部溶栓术+TIPS术+再狭窄单纯球囊成形术
病例17:门静脉内完全血栓——直接经皮肝穿刺门静脉定位+TIPS术
病例18:脾静脉血栓闭塞球囊成形术+门静脉血栓TIPS术
病例19:门静脉内血栓——经皮肝穿门静脉溶栓+取栓术
病例20:门静脉内血栓——经皮肝穿门静脉溶栓+取栓+门静脉成形术
病例21:门静脉海绵样变性、脾静脉狭窄合并直肠静脉出血——经皮肝穿刺门静脉技术+TIPS术+脾静脉成形术
病例22:脾切除后门静脉海绵状变性——直接TIPS术
病例23:门静脉血栓——经皮肝穿刺门静脉溶栓术+TIPS术

第六章 肝移植后门静脉并发症处理
病例24:门静脉狭窄——单支架成形术
病例25:门静脉狭窄——双支架成形术
病例26:门静脉血栓形成——溶栓+支架成形术
病例27:门静脉狭窄——双球囊成形术

第七章 顽固性腹水
病例28:顽固性腹水合并肝肾综合征——TIPS术
病例29:顽固性乳糜腹水合并肝癌——TIPS术
病例30:顽固性腹水合并凝血功能、肾功能严重异常——TIPS术

第八章 经皮肝穿技术
病例31:经皮肝穿胃冠状静脉栓塞术
病例32:经皮肝穿胃冠状静脉栓塞术+择期TIPS术
病例33:肝豆状核变性——经皮肝穿胃冠状静脉栓塞术+脾动脉部分栓塞术

第九章 TIPS术后再介入治疗
病例34:原分流通道支架塌陷再支架成形术
病例35:原分流通道异常球囊成形术
病例36:原分流通道闭塞-建立TIPS第二分流通道
病例37:原分流通道闭塞——经皮肝穿刺定位技术+第二分流通道TIPS术
病例38:颈静脉闭塞-咯右肱静脉途径治疗TIPS术后分流通道再狭窄
病例39:原TIPS分流通道通畅,再建立第二分流通道——TIPS术
病例40:原TIPs分流通道通畅,再建立第二分流通道——DIPS术

第十章 非常规穿刺技术建立TIPS分流通道
病例41:肝外门静脉建立TIPs分流通道
病例42:经左侧颈内静脉途径TIPS术

第十一章 急诊肝硬化门静脉高压消化道大出血的介入处理
病例43:急诊经皮肝穿胃冠状静脉栓塞术+TIPS术+分流通道再介人处理
病例44:急诊TIPS术+导管折叠技术栓塞异位曲张静脉

第十二章 肝恶性肿瘤合并肝硬化门静脉高压的介入治疗
病例45:TIPS术+TACE术+射频消融术+部分脾栓塞术+脾脓肿引流术十分流通道再介入治疗
病例46:巨大肿瘤并肝硬化门静脉高压_TACE术+TIPS术
病例47:门静脉血栓及肠系膜上静脉血栓合并肝癌——门静脉支架成形术+TIPS术+TACE术

第十三章 经验与教训
病例48:经皮肝穿门静脉技术+TIPS术——胸腔急性出血死亡
病例49:经皮肝穿门静脉技术+TIPS术——胸腔急性出血——外科手术
病例50:TIPS术合并胆道大出血
病例51:TIPS术肝外穿刺腹腔大出血
Book Abstract

三、门静脉高压的诊断和鉴别诊断
(一)临床表现
可以有肝炎、血吸虫病、黄疸、鼻出血、牙龈出血及上消化道出血史,或者有长期饮酒、慢性腹泻、腹胀、下肢水肿等史。体检,可以有黄疸、肝掌、蜘蛛痣及腹壁静脉曲张,肝脾肿大、腹水等。
(二)化验检查
血常规表现红细胞、白细胞及血小板减少,大便潜血试验可以阳性,凝血功能异常,血清总胆红素、转氨酶升高,白蛋白降低。乙肝、丙肝等相关的抗原抗体、蛋白电泳及免疫学检查可以表现异常。影像学检查:超声检查了解肝、脾大小和有无肝硬化、腹水及其严重程度,了解脾静脉、门静脉直径及有无血栓形成,门静脉血流量及血流方向等;X线钡餐检查观察有无食管、胃底静脉曲张,CT及MR可以观察肝脏脾脏的大小形态以及血管的直径及走行,对诊断很有帮助,必要时可作肝静脉、门静脉及下腔静脉造影。
(三)纤维胃镜检查
纤维胃镜检查可确定有无食管、胃底静脉曲张及其严重程度,以及有无出血危象。当食管静脉曲张破裂出血时,应与胃十二指肠溃疡,糜烂性胃炎,胃癌和呕吐源性食管黏膜破裂等相鉴别。详细询问病史,全面查体和化验检查,包括血象、肝功能检查、血氨测定等。胃十二指肠溃疡出血,一般有溃疡病史,脾不肿大、肝功能正常,在大出血之后一般不出现黄疸、腹水。这些都有助于鉴别。鉴别困难时,可行X线钡餐检查,纤维胃镜检查或选择性腹腔动脉造影等检查做出诊断。
第二节 肝脏血管解剖
肝的血管包括入肝血管和出肝血管两组。人肝血管包括肝固有动脉体系和进入肝内反复分支的门静脉,出肝血管是肝静脉体系。
一、肝固有动脉
由腹主动脉的腹腔干三大分支之一的肝总动脉发出的分支,为肝总动脉的延续,位于胆总管右侧和门静脉的前方上行至肝门,在肝门附近分为左、右终支人肝,人肝后分为肝右动脉和肝左动脉。
肝右动脉:入肝后右行,在右叶内分为前段动脉和后段动脉,分布于肝右叶前段和后段。前段动脉通常分为两支,即前上段动脉和前下段动脉,它们分别进入前段的后上部和前下部;后段动脉分为后上段动脉和后下段动脉,分别分布于肝右叶的后上段和后下段。
肝左动脉入肝后分为内侧段动脉和外侧段动脉,分别分布于左肝叶的内侧段和外侧段。内侧段动脉通常发出四条段支,即两条内上段动脉和两条内下段动脉;外侧段动脉为肝左动脉的终支,分为外上段动脉和外下段动脉,分布于肝左叶外上段和外下段。尾状叶的血液供应特殊,它不属于右叶也不属于左叶,依据尾状叶的尾状突、尾状叶右部和尾状叶左部三部分,它有三条独立的动脉进入尾状叶供血。
……

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Yami Gift Card

Get this exclusive deal when paying with gift card

Terms and Conditions

Gift card deals are special offers for selected products;

The gift card deals will automatically be activated if a customer uses gift card balance at check out and the balance is sufficient to pay for the total price of the shopping cart products with gift card deals;

You will not be able to activate the gift card deals if you choose other payment methods besides gift card. The products will be purchased at their normal prices;

If your account balance is not enough to pay for the products with gift card deals, you can choose to reload your gift card balance by clicking on the Reload button at either shopping cart page or check out page;

Products that have gift card deals can be recognized by a special symbol showing 'GC Deal';

For any additional questions or concerns, please contact our customer service;

Yamibuy reserves the right of final interpretation.

Sold by Yami

Service Guarantee

Yami Free Shipping over $49
Yami Easy Returns
Yami Ships from United States

Shipping

  • United States

    Standard Shipping is $5.99 (Excluding Alaska & Hawaii). Free on orders of $49 or more.

    Local Express is $5.99 (Available in Parts of CA, NJ, MA & PA). Free on orders of $49 or more.

    2-Day Express (Includes Alaska & Hawaii) starts at $19.99.

Return Policy

Yami is committed to provide our customers with a peace of mind when purchasing from us. Most items shipped from Yamibuy.com can be returned within 30 days of receipt of shipment (For Food, Beverages, Snacks, Dry Goods, Health supplements, Fresh Grocery and Perishables Goods, within 7 days of receipt of shipment due to damages or quality issues; To ensure that every customer receives safe and high-quality products, we do not provide refunds or returns for beauty products once they have been opened or used, except in the case of quality issues; Some products may have different policies or requirements associated with them, please see below for products under special categories, or contact Yami Customer Service for further assistance).
Thank you for your understanding and support.

Learn More

Sold by Yami

Terms and Conditions of Yami E-Gift Card

If you choose “Redeem automatically” as your delivery method, your gift card balance will be reload automatically after your order has been processed successfully;

If you choose “Send to Email”as your delivery method, the card number and CVV will be sent to the email address automatically;

Any user can use the card number and CVV to redeem the gift card, please keep your gift card information safely. If you have any trouble receiving email, please contact Yami customer service;

Yami gift card can be used to purchase both Yami owned or Marketplace products;

Yami gift card will never expire;

Yami gift card balance does not have to be used up at once;

All rights reserved by Yami.

Return Policy

Gift card that has already been consumed is non-refundable.

Sold by JD@CHINA

Service Guarantee

Yami Free Shipping over $49
Yami Easy Returns
Yami Ships from United States

Shipping

  • United States

    Standard Shipping is $5.99 (Excluding Alaska & Hawaii). Free on orders of $49 or more.

    Local Express is $5.99 (Available in Parts of CA, NJ, MA & PA). Free on orders of $49 or more.

    2-Day Express (Includes Alaska & Hawaii) starts at $19.99.

Return Policy

You may return product within 30 days upon receiving the product. Items returned must be new in it's original packing, including the original invoice for the purchase. Customer return product at their own expense.

Sold by JD@CHINA

Service Guarantee

Yami Cross-store Free Shipping over $69
Yami 30-days Return

Yami-China FC

Yami has a consolidation warehouse in China which collects multiple sellers’ packages and combines to one order. Our Yami consolidation warehouse will directly ship the packages to your door. Cross-store free shipping over $69.

Return Policy

You may return products within 30 days upon receiving the products. Sellers take responsibilities for any wrong shipment or missing items. Packing needs to be unopened for any other than quality issues return. We promise to pack carefully, but because goods are taking long journey to destinations, simple damages to packaging may occur. Any damages not causing internal goods quality problems are not allowed to return. If you open the package and any quality problem is found, please contact customer service within three days after receipt of goods.

Shipping Information

Yami Consolidation Service Shipping Fee $9.99(Free shipping over $69)

Sellers in China will ship their orders within 1-2 business days once the order is placed. Packages are sent to our consolidation warehouse in China and combined there. Our Yami consolidation warehouse will directly ship the packages to you via UPS. The average time for UPS to ship from China to the United States is about 10 working days and it can be traced using the tracking number. Due to the pandemic, the delivery time may be delayed by about 5 days. The package needs to be signed by the guest. If the receipt is not signed, the customer shall bear the risk of loss of the package.

Sold by JD@CHINA

Service Guarantee

Free shipping over 69
Genuine guarantee

Shipping

Yami Consolidated Shipping $9.99(Free shipping over $69)


Seller will ship the orders within 1-2 business days. The logistics time limit is expected to be 7-15 working days. In case of customs clearance, the delivery time will be extended by 3-7 days. The final receipt date is subject to the information of the postal company.

Yami Points information

All items are excluding from any promotion or points events on Yamibuy.com

Return Policy

You may return product within 30 days upon receiving the product. Items returned must be new in it's original packing, including the original invoice for the purchase. Customer return product at their own expense.

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Jingdong book

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Jingdong book