改良式TIPS的解剖学基础研究

Basic anatomic study of transjugular intrahepatic portosystemic shunt by direct transcaval approach

目的探讨肝硬化门脉高压患者下腔静脉、肝静脉与门静脉三者之间的影像解剖学关系,评估改良式TIPS,即经肝段下腔静脉入路经颈静脉肝内门体分流术的安全性与可行性。方法64例临床证实的肝硬化患者,肝功能Child-PughB级40例,C级24例,行肝脏双期增强扫描后行CT多层面重组(MPR)及曲面重建(CPR)后处理,将测量所得数据进行配对t检验。结果Child-PughB级者肝段下腔静脉的长度与C级者相比前者较长(P<0.05)。以肝段下腔静脉穿刺点为A1,肝右静脉开口2cm处的穿刺点为A2,门静脉分叉部穿刺点为B1,门静脉右支开口2cm处的穿刺点为B2,A1B1线的长度与A2B1线的长度相比前者较短(P<0.05),A1B2线和A2B2线与B2点所在门静脉右支径线的夹角大小相比前者较小(P<0.05)。A1B1线和A1B2线分别与所在门静脉径线的夹角相比前者较大(P<0.05),A2B1线和A2B2线分别与所在门静脉径线的夹角相比前者较大(P<0.05)。结论从解剖学角度分析,改良式TIPS具备安全性及可行性,较传统TIPS术式还具有分流道走行顺畅,对血流动力学影响小的优点。

Objective To investigate the indications and related anatomic foundation of transjugular intrabepatic portosystemic shunt （TIPS）through direct transcaval approach, and to evaluate the safety, feasibility and clinical significance. Methods Sixty four patients diagnosed as hepatoeirrhosis clinically were involved, including the function of liver Child B （n=40）, Child C （n=24）. After 2 phrase of hepatic CT enhancement scanning and postprocessing through multiple planner reconstruction （MPR） and curve planner reconstruction （CPR）, the data were conjugated statistically by ANOVA. Results The length of the intrabepatic segment of the inferior cava in Child B is longer than that in Child C （P 〈 0.05）. Refering the points of hepatic vein entrance to vena cava as A1, 2 cm away from right hepatic vein as A2, the crotch of portal vein as B1,2 cm away from right portal vein as B2. The length of A1B1 is shorter than that of A2B1 （P 〈0.05）.The angle between A1B2 and right portal vein is smaller than that of A2B2 and right portal vein （P〈0.05）. Conclusion Transcaval TIPS creation is safe and feasible, providing the direct transcaval approach as a favorable fluent patency way and less influence on hemodynamics in comparison with traditional TIPS. （J Intervent Radiol, 2007, 16： 316-319）