C臂CT辅助经颈静脉肝内门体分流术治疗门静脉高压症的初步临床观察

Preliminary clinical study of C-arm CT assisted transjugular intrahepatic portosystemic shunt for the treatment of portal hypertension

目的探讨C臂CT在经颈静脉肝内门体分流术(TIPS)中的应用价值。方法回顾性分析2015年6月至2017年10月,收治的16例肝硬化门静脉高压伴食管胃底静脉曲张破裂出血或顽固性腹水患者的临床资料。患者术前常规行腹部增强CT扫描,并通过工作站制作门静脉序列后处理图像,在择期手术进行时与术中C臂CT图像融合后实时引导TIPS术。结果患者C臂CT辅助TIPS均成功,术中门静脉造影显示门静脉位置与CT融合图像参考位置基本一致,患者无腹腔出血、胆道损伤等并发症发生。穿刺针数为1.0~4.0针/例,平均(2.1±0.9)针/例;门静脉穿刺透视用时2.0~8.0min/例,平均(4.3±1.9)min/例;总透视时间17.0~32.0min/例,平均(22.6±4.8)min/例;手术辐射面积剂量(DAP)为(256.2±96.7)mGy/cm2。结论C臂CT路图引导下的TIPS术可行、安全。

Objective To explore the value of C-arm CT in transjugular intrahepatic portosystemic shunt(TIPS).Methods Between June 2015 and October 2017,a total of 16 patients with cirrhosis complicated by upper gastrointestinal bleeding or massive ascites due to portal hypertention in our center were retrospectively enrolled in the study.Abdominal enhanced CT was routinely performed before surgery.Postprocessing images of portal vein were used as a guidance of TIPS in real time after integrated with intraoperative c-arm CT images during selective operations.Results The success rate of C-arm CT-guided TIPS was 100%.Portal vein angiography showed the position basically consistent with CT matched images reference position.No obvious abdominal hemorrhage,injury of biliary tract and other complications occurred in all patients.The mean number of needle passes was 2.1±0.9 passes(range of 1.0-4.0 passes),the mean time of portal vein entry was 4.3±1.9 min(range of 2.0-8.0 min),the mean fluoroscopy period was 22.6±4.8 min(range of 17.0-32.0 min),DAP was(256.2±96.7)mGy/cm2.Conclusion C-arm CT-guided TIPS is technically feasible and safe.