摘要
目的探讨经颈静脉肝内门腔分流术(TIPSS)后肝血流的变化情况以及两者之间的关系。方法对9例因肝硬化而实施 TIPSS 的患者术前1周、术后72 h 进行 CT 灌注扫描,并在分流通道建立前、后进行门静脉测压。其中3例患者在术后3个月和6个月复查了 CT 灌注扫描成像。所有患者在术后48 h 内进行了 Doppler 超声检查,并于术后3个月(9例)和6个月(6例)行 Doppler 超声复查。2例患者在术后6个月进行了 TIPSS 支架造影和门静脉测压。结果全部患者术前门静脉灌注量(PVP)为(0.92±0.18)ml·min^(-1)·ml^(-1),总灌注量(THBF)为(1.28±0.17)ml·min^(-1)·ml^(-1),动脉灌注指数(HPI)为(28±8)%,门静脉自由压(PVFP)为(23.92±0.86)mm Hg(1 min Hg=0.133 kPa);术后72 h 测得 PVP 为(0.21±0.15)ml·min^(-1)·ml^(-1),THBF 为(0.74±0.18)ml·min^(-1)·ml^(-1),HPI 为(74±13)%,PVFP 为(12.62±1_54)mm Hg;术后3个月和6个月 PVP 分别为(0.49±0.05)ml·min^(-1)·ml^(-1)和(0.57±0.03)ml·min^(-1)·ml^(-1);术前 PVP 与 PVFP 之间存在负相关(r=0.678,P<0.05),术后 PVP 与 PVFP 之间无线性相关性(r=0.543,P>0.05),TIPSS 导致PVFP 平均值下降梯度与门静脉灌注减少量之间存在正相关(r=0.867,P<0.01)。Doppler 超声监测TIPSS 术后48 h 肝门静脉血流情况:主干为(27.9±3.4)cm/s,支架内为(62.6±6.4)cm/s;肝内门静脉分支均为出肝血流,门静脉左支(18.9±7.2)cm/s、右支为(6.6±3.2)cm/s。术后6个月主干为(15.6±1.1)cm^3/s,支架(9.8±5.7)cm^3/s。结论 TIPSS 术后 PVFP 平均值下降的同时伴有大量门静脉血流成为无效灌注,无效 PVP 与 PVFP 平均值下降直接相关。肝动脉无法代偿门静脉有效灌注量的下降。
Objective To evaluate hemodynamic changes in liver treated by transjugular intrahepatic portosystemic stent-shunt （TIPSS） with hepatic computed tomography （CT） perfusion, Doppler ultrasound and portal vein pressure measurement, as well as the correlation among these methods. Methods Hepatic CT perfusion was performed in 9 cirrhotic patients one week before TIPSS and 72 hours after TIPSS. Intraoperative portal vein pressure was measured before and after portosystemic shunt establish. The follow- up hepatic CT perfusion were carried out in 3 cases at 3 months and 6 months postoperatively. The hemodynamic surveillance by Doppler ultrasound were performed in 48 hours and 3 months after TIPSS for 9 cases, and in 6 months after TIPSS for 6 cases. Two cases underwent venography and portal vein pressure measurement in 6 months after TIPSS treatment. Results The mean of portal vein perfusion （ PVP）, total hepatic blood flow （THBF） , hepatic perfusion index （HPI） and portal vein free pressure （PVFP） before TIPSSwere （0.92±0.18）ml·min^-1·m1^-1, （1.28±0.17）ml·min^-1·m1^-1, （28 ±8） %, and （23.92 ± 0. 86） mmHg, respectively. In 72 hours after TIPSS, the mean of PVP, THBF, HPI and PVFP were （0.21 ±0.15）ml·min^-1·m1^-1, （0.74 ±0.18） ml·min^-1·m1^-1, （74 ± 13） %, and （ 12. 62 ± 1.54） mm Hg, respectively. After treatment, the mean of PVP was （0. 49 ±0. 05 ） ml·min^-1·m1^-1 at 3 months and （0.57 ±0.03） ml·min^-1·m1^-1 at 6 months, respectively. There was negative correlation between PVP and PVFP before TIPSS （ r = 0. 678, P 〈 0. 05 ）, but there was no correlation between them after TIPSS （ r = 0. 543, P 〉 0. 05 ）. Moreover, a significant correlation was found between the degree of portal vein pressure decrease and portal vein perfusion decrease （ r = 0. 867, P 〈 0. 01 ）. In addition, the mean of blood flow rate （BFR） of portal vein detected by Doppler ultrasound after TIPSS in 48 hours were as follows ： （ 27.9 ± 3.4 ）
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2007年第12期1374-1378,共5页
Chinese Journal of Radiology
基金
国家自然科学基金(30270417)
广东省医学科研课题项目(B2006025)
