经皮穿刺直接性门腔静脉分流术的影像学研究

Radiological study on percutaneous direct intrahepatic portacaval shunt

目的通过对肝硬化并门脉高压症患者的影像学研究,进一步明确肝内门静脉(PV)与肝后段下腔静脉(RHSIVC)的关系,探讨在彩超(CDFI)导引下经皮穿刺行直接性门腔静脉分流(DIPS)术的可行性及安全性。方法随机选择肝硬化并门脉高压症患者30例,利用CDFI、CT、MR进行肝脏二维或三维多切面扫描,并测量RHSIVC长度、被肝实质包绕的RHSIVC长度、以及肝内LPV和RPV距PV分叉部1cm处及PV分叉部与同层面RHSIVC之间的距离。结果三种影像学方法测量的RHSIVC长度、被肝实质包绕的RHSIVC长度、肝内LPV距PV分叉部1cm处与同层面RHSIVC之间的距离、肝内RPV距PV分叉部1cm处与同层面RHSIVC之间的距离、PV分叉部与同层面RHSIVC之间的距离,均无显著性差异(P>0.05)。结论CDFI、CT、MR均能准确显示PV及RHSIVC,RHSIVC起、止层面的横断面平均有56.7%、93.1%的管腔被周围肝实质完全包绕,在CDFI导引下经皮穿刺肝内PV再至RHSIVC行DIPS术是安全、可行的。

Objective To explore the feasibility and security of DIPS procedure through anatomic study of adult liver specimens and radiological study of cirrhotic patients,of CD（color Doppler）-guided DIPS operations by percutaneous direct portal venocentesis to retrohepatic segment of inferior vena cava,and evaluate their preliminary clinical effects.Methods 30 chronic cirrhotic patients were randomly selected to undergo 2 or 3 dimentional multiple CDFI, CT or MR screening to measure the size, shape, resonance of the liver; the inner diameter, pathway and flow velocity of the right and left branch of portal vein; the diameter, length of RHSIVC and the radius of liver parenchyma; the nearest distance from the right and left branch of portal vein to RHSIVC respectively.Results There were not significant differences among the lengths of RHSIVC,the lengths of RHSIVC enclosed by liver parenchyma, the distance from the right branch of intrahepatic portal vein to the portal branch and to RHSIVC which were all measured by CDFI,CT and MR（P〉0.05）.Conclusion CDFI,CT and MR can all clearly reveal the anatomy of RHSIVC and the portal vein. The average length of RHSIVC is 60.56±4.23mm. At the beginning and ending transect of RHSIVC, about 56.7%and 93.1%of the lumen are enclosed completely by liver parenchyma, which assures the safe performance of DIPS.