超声引导穿刺联合双向造影在经颈静脉肝内门体分流术中的应用研究

Application study of ultrasound-guided percutaneous portal vein punctures combined with bi-directionalangiography in the treatment by TIPS

目的探讨超声引导穿刺门静脉联合双向造影在经颈静脉肝内门体分流术(TIPS)术中的安全性、可行性和初步临床经验。方法选取2016年01月至2018年6月TIPS术中应用超声引导穿刺门静脉联合双向造影患者15例,设为实验组;随机选取同期采用传统TIPS患者30例,设为对照组。两组患者基本情况差异无统计学意义。记录患者穿刺针数、射线暴露时间及并发症等情况。不服从正态分布的计量资料采用非参数检验,计数资料比较采用χ2检验。结果实验组技术成功率为100%,对照组技术成功率为96.77%。实验组穿刺针数为1~3针,共32针(2.13±0.74)针,对照组穿刺针数为1~11针,共125针(4.16±2.13)针,实验组较对照组穿刺针数明显减少,差异有统计学意义(P < 0.001)。实验组射线暴露时间为18~46(29.64±8.79)min,对照组射线暴露时间为12~150(44.57±26.84)min,实验组较对照组射线暴露时间明显减少,差异有统计学意义(P = 0.023)。结论超声引导穿刺门静脉联合双向造影在TIPS术中安全、可行,该方法与传统TIPS相比,可明显缩短术中射线暴露时间、减少术中穿刺针数,减少对肝脏的损伤。

Objective To investigate the safety, feasibility, and preliminary clinical experience of ultrasonic guided percutaneous portal vein punctures combined bi-directional angiography in the treatment by transjugular intrahepatic portosystemic shunt(TIPS). Methods From January 2016 to June 2018, 15 patients with TIPS from our hospital who were treated by ultrasonic guided percutaneous portal vein punctures combined with bi-directional angiography were enrolled,and were recruited as experimental group. During the same period, 30 patients who were treated by TIPS combined with traditional methods were enrolled, and were recruited as control group. There was no statistical difference in baseline characteristics between the two groups (P > 0.05). The portal pressure difference in preoperative and postoperative, the fluoroscopy time, the number of puncture needles and complications were recorded. After treatment, the patients were followed up through outpatient service or telephone method. Results The technical success rate was 100% in experimental group, and 96.7% in control group. In the experimental group, number of percutaneous transhepatic portal vein puncture by needle was 1-3 (average, 2.13 ± 0.74), and the number of portal vein puncture needles in the control group were 1-11 (average, 4.16 ± 2.13). The number of puncture needles in the experimental group were significantly decreased than in the control group (P < 0.001). In the experimental group, the fluoroscopy time was 18 ~ 46 (average 29.64 ± 8.79) minutes. In the control group, the fluoroscopy time was 12 ~ 150 (average 44.57 ± 26.84) minutes.The fluoroscopy time was significantly reduced in the experimental group compared with the control group(P = 0.023). Conclusion Ultrasound-guided portal vein combined with bidirectional angiog-raphy is safe, feasible, and reliable in the treatment by TIPS. Compare with traditional TIPS, it can reduce the fluoroscopy time, the number of puncture needles and the liver injury.