三维打印辅助TIPS治疗肝硬化食管胃底静脉曲张出血

3D printing-assisted TIPS for the treatment of cirrhotic esophagogastric variceal hemorrhage

目的探讨三维打印辅助经颈静脉肝内门体分流术(TIPS)治疗肝硬化食管胃底静脉曲张出血的临床价值。方法30例肝硬化伴食管胃底静脉曲张出血患者随机分为病例组(n=15)和对照组(n=15)。病例组患者术前接受肝脏CT薄层扫描和门静脉系统CT静脉造影(CTV),根据扫描数据按1∶1打印肝脏血管模型,进行体外模拟穿刺,并调整RUPS-100型经颈静脉肝内穿刺系统穿刺针角度,制定最佳穿刺路径后行TIPS;对照组患者术前接受肝脏CT薄层扫描和门静脉系统CTV检查,凭经验行TIPS。比较两组术中穿刺针数、时长、穿刺成功率和穿刺相关并发症发生率。结果两组穿刺成功率均为100%。病例组穿刺针数、时长、穿刺相关并发症发生率均低于对照组,差异均有统计学意义(P<0.05)。结论三维打印辅助TIPS可减少穿刺次数,缩短穿刺时间,降低穿刺相关并发症发生率。

Objective To discuss the clinical value of 3D printing- assisted transjugular intrahepatic portosystemic shunt(TIPS) in treating cirrhotic esophagogastric variceal hemorrhage.Methods A total of 30 cirrhotic patients with esophagogastric variceal bleeding were randomly and equally assigned into study group and control group,with 15 patients in each group.Patients in the study group underwent preoperative CT thin-slice scanning of liver and CT venography(CTV) of portal vein system.Based on the scanning data,hepatic vascular model at 1∶1 ratio was printed.Simulated puncturing was tried in vitro,and the angle of needle of RUPS- 100 transjugular intrahepatic puncture system was adjusted until optimal puncture path for TIPS was found out.For the patients of the control group,preoperative CT thin - slice scanning of liver and CTV was performed,and TIPS was accomplished based on operator's experience.The number of puncturing times,the time used for puncturing,the success rate of puncturing and the occurrence of puncture- related complications were compared between the two groups.Results The success rate of puncturing was 100% in both groups.The number of puncturing times,the time used for puncturing and the occurrence of puncture-related complications in the study group were remarkably lower than those in the control group,the differences in the above indexes between the two groups were statistically significant (P<0.05).Conclusion 3D printing- assisted TIPS can reduce the number of puncturing times,shorten the time used for puncturing,and decrease the incidence of puncture-related complications.