CO_2与含碘液性造影剂行肝静脉楔入法造影显示门静脉的能力

Identifi cation of portal vein: wedge hepatic venography with carbon dioxide and iodinated contrast

目的回顾性分析应用二氧化碳气体（ＣＯ２）和含碘液性造影剂（ＩＣ）行肝静脉楔入法造影，探讨两种不同方法显示门静脉的能力。方法在４３例行经颈静脉肝内门体静脉分流术（ＴＩＰＳ）治疗的患者中，门静脉穿刺前行肝静脉楔入法造影，２３例应用ＣＯ２，２０例用ＩＣ。４２例门静脉穿刺后应用ＩＣ行直接法门静脉造影。分析应用两种造影剂行肝静脉楔入法造影显示门静脉的结果，并同直接法造影加以比较。结果在肝静脉楔入法造影中，应用ＣＯ２门静脉显示优良者为９１％（２１／２３），应用ＩＣ，则仅为１０％（２／２０）。ＣＯ２楔入法同直接法相比，结果基本一致以上者为８７％（２０／２３），而ＩＣ为１０％（２／２０）。３例ＴＩＰＳ失败者，２例行ＣＯ２楔入法造影显示了门静脉结构异常，１例未行ＣＯ２楔入法造影。结论应用ＣＯ２行肝静脉楔入法造影，可更容易和准确地显示门静脉的解剖结构。

Purpose To evaluate the utility of CO 2, vs iodinated contrast(IC) for wedge hepatic venography(WHV) to identify portal vein anatomy prior to transjugular intrahepatic porto systemic shunt(TIPS). Methods Retrospective analysis was done on WHV and direct portography using CO 2 or IC. WHV and direct portography were performed in 43 cases during TIPS procedures. WHV was performed with CO 2 in 23 cases and with IC in 20. Direct portography was performed with IC in all except one case. All cases were reviewed to assess comparability of portal vein anatomy between WHV and direct portography. Results With CO 2 and IC, portal vein appearance was good to excellent in 91%(21/23); and in 10%(2/20), separately as judged by opacification of main portal trunk and/or branches with definition of the portal bifurcation. Agreement between WHV and direct portography was obtained in 87% (20/23) with CO 2 and 10% (2/20) with IC. TIPS procedures were not successful in 3 cases, CO 2 WHV identified abnormal morphology, in two cases and in the remaining one no WHV was performed. Conclusion WHV with CO 2, as compared to IC, has a substantially higher likelihood of correctly and completely identifying portal vein location and anatomy.