彩色多普勒超声在TIPSS围手术期及远期疗效评价中的临床应用

Clinical application of CDFI in the perioperative, middle and long-term efficacy evaluation of TIPSS

目的:探讨彩色多普勒超声在经颈内静脉肝内门体静脉支架分流(TIPSS)围手术期及中、远期疗效评价中的临床应用价值。方法:对拟行TIPSS术的门脉高压症患者行CDFI检查,包括肝脏、脾脏解剖学及肝内血管毗邻解剖学观察,门静脉血流的测定、肝动脉血流的测定、术后支架功能的测定;建立门静脉压力与门静脉血流量的回归方程。结果:1)门静脉术后不同时期先内径减小,然后呈逐渐加大趋势;血流速度术后加快然后缓慢下降;血流量术后增加,然后缓慢下降;充血指数术后下降,然后缓慢增加。2)肝动脉血流围手术期及中、远期肝动脉各参数均值均无显著差异。3)术中测量门静脉压力为(37.59±7.44)cmH2O(26~52 cmH2O),门静脉压力与其血流量回归方程为:Y^(Ppv,cmH2O)=16.302+0.018X(Qpv,mL/min)。结论:彩色多普勒超声可以为TIPSS提供快捷、方便、实时、有效的影像学评估,并可以量化、客观、准确、全面的评估TIPSS各时期相关的血流动力学特征,是TIPSS术前筛查、术中指导、术后复查及中、远期评价的良好手段,可以指导TIPSS诊疗的全过程。

Objective:To discuss the clinical application value of CDFI in the perioperative,middle and long-term efficacy evaluation of TIPSS.Methods:CDFI examination was performed on TIPSS patients with portal hypertension,including liver,spleen anatomy and adjacent anatomy of intrahepatic vessels,determination of portal vein blood flow,determination of hepatic artery blood flow,and determination of postoperative stent function;The regression equation of portal venous pressure and portal venous blood flow was established.Results:1)the inner diameter decreases at different periods after portal vein surgery,and then gradually increases,The velocity of blood flow increased after surgery and then decreased slowly.Blood flow increased after surgery and then slowly decreased.The decongestant index decreased after surgery and then increased slowly.2)there was no significant difference in the mean values of perioperative,middle and long-term hepatic artery parameters.3)intraoperative portal vein pressure was measured as(37.59±7.44)cmH2O(26~52 cmH2O),and the regression equation of portal vein pressure and blood flow was Y^(Ppv,cmH2O)=16.302+0.018x(Qpv,mL/min).Conclusion:CDFI can provide fast,convenient,real-time and effective imaging evaluation for TIPSS,and can be quantitative,objective,accurate and comprehensive evaluation of TIPSS related the hemodynamic characteristics of different periods is TIPSS,intraoperative guidance,preoperative screening,forward in postoperative review and evaluation of good,can guide the whole process of TIPSS diagnosis and treatment.