TIPSS术后内支架血流状况的彩色多普勒检测

An Investigation of Shunt Patency with CDFI after TIPSS

目的：探讨彩色多普勒超声（ＣＤＦＩ）评价内支架血流状况的应用价值。材料和方法：３１例肝硬化门脉高压患者行ＴＩＰＳＳ术。术前进行常规ＣＤＦＩ检查，术后复查，观察门脉及内支架血流变化，测量血流速度。结果：２９例手术成功，２例失败。术前门脉血流速度（１７２±４７）ｃｍ／ｓ，术后（５１２±１４７）ｃｍ／ｓ，内支架血流速度（１４１±２９１）ｃｍ／ｓ。１３例术后门脉左右分支血流由“进肝流向”转为“离肝流向”；当内支架狭窄及闭塞时又转为“进肝流向”。４例支架内血流速度＜８０ｃｍ／ｓ，门脉造影显示内支架狭窄；４例支架内无血流信号，造影证实内支架已闭塞。结论：ＣＤＦＩ是检测内支架血流状况的简便、准确方法。支架内血流速度＜８０ｃｍ／ｓ，提示内支架狭窄存在；支架内无血流信号，表明内支架已闭塞。术后门脉分支“离肝流向”血流也是内支架血流通畅的间接可靠依据。

Purpose: To investigate the usement of color Doppler flow imaging (CDFI) in evaluation of stent patency. Materials and Methods: 31 cases of liver cirrhosis with portal hypertension were performed TIPSS. All cases regularly underwent CDFI examination before and after TIPSS. The color Doppler flow in portal veins and stents was observed, and the flow velocity was measured. Results: The procedures succeeded in 29 cases, 2 cases failed. Before TIPSS, flow velocity in portal veins was 17.2±4.7cm/s; and after that, it was 51.2±14.7cm/s; the flow velocity in stents was 141±29.1cm/s. The flow direction in left and right portal branches in 13 cases changed from “hepatopatal” to “hepatofugal” after TIPSS; if stenosis or occlusion occured in stent, the direction was recorved again. The peak velocity in stent of 4 cases was less than 80cm/s, the venography showed the stents were stenosed. Doppler flow signals in stents were not detected in anather 4 cases, angiography cnofirmed occlusion of the stents. Conclusion: CDFI may be an simple, accurate method to follow stent patency. The peak velocity in the stent <80cm/s indicated the stent was stenosed; no Doppler flow signals in it suggested it was occluded. “hepatofugal”in portal branches after TIPSS may also an indirect, reliable sign of stent patency.