摘要
目的评价三维可视化技术在经颈静脉肝内门-体静脉分流术(TIPS)治疗肝静脉广泛闭塞布加综合征(BCS)中的应用价值。方法搜集21例肝静脉广泛闭塞BCS患者,男11例,女10例,平均年龄(39.7±14.3)岁。选取患者磁共振血管成像(MRA)或CT血管成像(CTA)扫描数据,以医学数字成像和通信(DICOM)文件格式导入Mimics 3D建模软件,构建下腔静脉、门静脉和肝动脉三维可视化模型,并在三维可视化模型引导下施行TIPS。结果21例患者均成功构建三维可视化模型:3支肝静脉广泛闭塞21例,下腔静脉通畅16例、闭塞5例。根据模型进行术前规划,测得下腔静脉预计穿刺点(A)至门静脉预计穿刺点(B)所在冠状面、矢状面、横断面的垂直距离AB1、AB2、AB3分别为(22.7±11.8)mm、(16.2±10.8)mm、(47.4±10.3)mm;穿刺路径(AB)与下腔静脉远心端的角度为(36.1±6.0)°。在三维可视化模型引导下,全部患者均成功施行TIPS,均无并发症。门静脉压力梯度(PPG)由术前平均(22.9±5.8)mmHg降至术后平均(9.8±2.5)mmHg(t=10.51,P<0.05)。结论三维可视化技术辅助TIPS治疗肝静脉广泛闭塞BCS安全可行,具有较好的临床应用价值。
Objective To evaluate the application value of three-dimensional visualization technique in the treatment of Budd-Chiari syndrome(BCS)with extensive occlusion of the hepatic veins by transjugular intrahepatic portosystemic shunt(TIPS).Methods Twenty-one BCS patients with extensive hepatic veins occlusion were selected,including 11 males and 10 females,with a mean age of(39.7±14.3)years.The MRA or CTA scanning data of patients were extracted and imported into Mimics 3 D modeling software in the format of DICOM.Three-dimensional visualization models of inferior vena cava,portal vein and hepatic artery were constructed,and TIPS was performed under the guidance of three-dimensional visualization model.Results Three-dimensional visualization models was successfully constructed in 21 patients:all 21 cases with extensive occlusion of three hepatic veins,16 cases with patent inferior vena cava and 5 cases with occlusion of inferior vena cava.Preoperative planning was carried out according to the model.The vertical distance from the expected puncture point of inferior vena cava(A)to the expected puncture point of portal vein(B)in the coronal plane(AB1),sagittal plane(AB2),and axial plane(AB3)was(22.7±11.8)mm,(16.2±10.8)mm,and(47.4±10.3)mm,respectively.The angle between the puncture path(AB)and the distal end of inferior vena cava measured according to the model was(36.1±6.0)°.Under the guidance of three-dimensional visualization model,all patients were treated successfully with TIPS without any complications.The portal venous pressure gradient dropped from the mean(22.9±5.8)mmHg before treatment to the mean(9.8±2.5)mmHg after treatment(t=10.51,P<0.05).Conclusion Three-dimensional visualization technique is safe and feasible to assist TIPS in the treatment of BCS with extensive occlusion of the hepatic veins,and it has specifically clinical application value.
作者
全坤
沙俊诚
张庆桥
徐浩
肖晋昌
神斌
魏宁
崔艳峰
刘洪涛
祖茂衡
QUAN Kun;SHA Juncheng;ZHANG Qingqiao(Department of Interventional Radiology,The Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu Province 221006,P.R.China)
出处
《临床放射学杂志》
北大核心
2021年第8期1594-1598,共5页
Journal of Clinical Radiology
基金
江苏省研究生科研与实践创新计划项目(编号:SJCX20-0926)。
关键词
布加综合征
经颈静脉肝内门-体静脉分流术
三维可视化
Budd-Chiari syndrome
Transjugular intrahepatic portosystemic shunt
Three-dimensional visualization
