实时三维超声血管成像在经颈静脉肝内门体分流术前的应用价值

The preoperative application of real-time three-dimensional ultrasound image in transjugular intrahepatic portosystemic shunt

目的探讨实时三维超声(RT 3D-US)在经颈静脉肝内门体分流术(TIPS)前血管成像中的应用价值。方法 30例肝硬化门静脉高压合并上消化道出血或大量腹水行TIPS的患者,术前应用实时三维超声行肝内血管成像,明确肝右静脉和门静脉右支的空间走行关系,选取穿刺位点、测量穿刺角度和二者间的距离以及了解有无肝包膜包裹。结果 RT 3D-US彩色血流成像可以实现对肝内门静脉、肝右静脉走行及空间关系的直观显示,矢状面观肝右静脉距下腔静脉开口2cm处与门静脉右支的平均距离为(3.8±1.3)cm,平均角度为(39.1±8.3)°。运用RT 3D-US多平面成像技术可以确定门静脉周围是否有肝组织及肝包膜,并提示裸露的部位。根据术前RT 3D-US血管成像制定穿刺路径和角度,术中一次穿刺成功26例(86.7%),2次穿刺成功4例(13.3%),术中未出现严重并发症。结论应用无创RT 3DUS可以直观再现肝硬化患者肝内血管的空间走行及相互关系,有助于指导TIPS术前制定手术方案,减少穿刺并发症,可在临床推广应用。

Objective To evaluate the clinical application of preoperative real-time three-dimensional ultrasound RT 3D-US） in performing transjugular intrahepatic portosystemic shunt. Methods 30 patients with cirrhosis complicat- d by upper gastrointestinal bleeding or massive ascites due to portal hypertension were enrolled in this study. The pa- ents were arranged to receive TIPS. Before the treatment, RT 3D-US was performed in all patients. By using color Doppler flow image to display the hepatic veins and portal vein and demonstrate the location and width of the portal and epatic veins. Results RT 3D-US could clearly display morphologic changes of liver, the spatial relationship of the portal ad hepatic veins. The distant from the puncture point of 2cm away from the opening of right hepatic vein to the right ranch of the portal vein was （3.8± 1.3）cm, the angle was （39.1 ± 8.3）°. Twenty-six cases were successful punctured nly one time, and 4 eases two times. Conclusion As a noninvasive and reliable method, RT 3D-US can provide important anatomical information about the portal venous and hepatic venous system and basis for formulating individual zhemes before TIPS,and decrease the complications about puncture.