摘要
目的评估3D影像融合在经颈静脉肝内门体分流(transjugular intrahepatic portosystemic shunt,TIPS)术中的应用价值。方法回顾性分析2018年1月~2021年12月TIPS治疗肝硬化门静脉高压症44例资料。18例术中以3D影像融合引导(影像融合组),即在ARTIS pheno血管造影系统应用Syngo-X-workshop软件将术前肝脏门脉期增强CT与术中锥形束CT图像融合,以融合的3D影像导引TIPS;另26例以术前影像评估及术中间接门静脉造影引导行TIPS手术(常规手术组)。2组性别、年龄、术前Child-Pugh评分、血红蛋白、血清总胆红素、白蛋白、凝血酶原时间、门静脉直径、腹水量及食管胃底静脉曲张严重程度均无统计学差异(P>0.05)。对比2组手术相关数据。结果影像融合组门静脉穿刺次数、手术时间、透视时间、碘对比剂用量及手术射线剂量均显著少于常规手术组[(2.1±1.1)次vs.(4.1±1.8)次,t=-4.428,P=0.000;(88.4±13.7)min vs.(115.2±33.0)min,t=-3.699,P=0.001;(17.7±4.6)min vs.(26.6±12.0)min,t=-2.986,P=0.005;(88.3±19.2)ml vs.(111.0±23.5)ml,t=-3.373,P=0.002;(655.3±128.5)mGy vs.(971.7±381.5)mGy,t=-3.920,P=0.000]。结论3D影像融合用于TIPS安全、可行,可提高TIPS术中门静脉穿刺成功率,减少射线暴露和碘对比剂用量。
Objective To evaluate the application value of 3D image fusion in transjugular intrahepatic portosystemic shunt(TIPS).Methods Clinical data of 44 patients with portal hypertension of cirrhosis treated with TIPS from January 2018 to December 2021 were retrospectively analyzed.The operation was guided by 3D image fusion in 18 cases(image fusion group),during which the preoperative enhanced CT(portal phase)was fused with the intraoperative cone beam CT image by Syngo-X-workshop software(ARTIS pheno angiography system)and TIPS procedure was guided under the 3D image.The other 26 patients underwent TIPS guided with preoperative imaging evaluation and intraoperative indirect portal venography(routine operation group).There were no significant differences in gender,age,preoperative Child-Pugh scores,hemoglobin,serum total bilirubin,albumin,prothrombin time(PT),portal vein diameter,ascites,and gastroesophageal varices severity between the two groups(P>0.05).The data related to operation were compared between the two groups.Results In the image fusion group,attempts of portal vein puncture,operation time,radiation time,iodine contrast agent dosage,and radiation dose were all significantly lower than those of routine operation group[(2.1±1.1)times vs.(4.1±1.8)times,t=-4.428,P=0.000;(88.4±13.7)min vs.(115.2±33.0)min,t=-3.699,P=0.001;(17.7±4.6)min vs.(26.6±12.0)min,t=-2.986,P=0.005;(88.3±19.2)ml vs.(111.0±23.5)ml,t=-3.373,P=0.002;(655.3±128.5)mGy vs.(971.7±381.5)mGy,t=-3.920,P=0.000].Conclusion Application of 3D image fusion in TIPS is safe and feasible,which can increase success rate of portal vein puncture,and reduce the radiation exposure and dosage of iodine contrast agent.
作者
许太福
侯培勇
苏奕明
魏立春
吴菲
Xu Taifu;Hou Peiyong;Su Yiming(Department of Vascular Surgery,Fourth Affiliated Hospital of Guangxi Medical University,Liuzhou 545005,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2023年第5期336-340,共5页
Chinese Journal of Minimally Invasive Surgery
基金
柳州市科技局重点研发项目(2019BJ10606)。
