TIPS术中DSA间接门静脉造影的影响因素分析及质量控制

Analysis of Influencing Factors and Quality Control of DSA Indirect Portography During TIPS

目的:探讨TIPS术中DSA间接门静脉造影的影响因素分析及质量控制。方法:选取2016年12月~2020年3月收治的85例TIPS手术患者术中行DSA间接门静脉造影,其中66例经肠系膜上动脉间接门静脉造影,6例经脾动脉间接门静脉造影,13例经肝动脉间接门静脉造影,分别进行图像质量评分以及对临床病理因素进行数据分析。结果:经肠系膜上动脉间接门静脉造影66例:其中46例>4分(占比69.6%),显影较好或清晰;经脾动脉间接门静脉造影6例,其中3例>4分,显影清晰(占比50%);经肝动脉间接门静脉造影15例其中10例>4分显影清晰(占比66.7%)。单因素分析和多因素分析均提示门静脉主干内经>1.5cm和侧枝血管内经总和>0.5cm是影响肠系膜上动脉间接门静脉造影结果的独立因素。结论:在TIPS术前根据患者门静脉和侧枝血管情况选择个体化DSA间接门静脉造影程序,门静脉主干内经和侧枝血管内经越大,间接门静脉显影越差。

Objective:To investigate the influencing factors and quality control of DSA indirect portography during TIPS.Methods:A total of 85 patients undergoing DSA indirect portal venography during the operation from December 2016 to March 2020 were selected for TIPS surgery.Among them,66 patients received indirect portal venography via superior mesenteric artery,6 patients received indirect portal venography via splenic artery,and 13 patients received indirect portal venography via hepatic artery.Portal vein angiography,image quality scoring and clinical pathological factors for data analysis.Results:Indirect portography through superior mesenteric artery was performed in 66 cases,of which 46 cases were more than 4 points(69.6%),6 cases were indirect portal venography through splenic artery,3 cases were more than 4 points,and the development was clear(50%).Of the 15 cases of indirect portal venography via hepatic artery,10 cases developed clearly with>4 points(accounting for 66.7%).Univariate analysis and multivariate analysis showed that the internal meridians of the main portal vein>1.5cm and the sum of intravascular meridians of the collateral vessels>0.5cm were the independent factors affecting the results of indirect portography of the superior mesenteric artery.Conclusion:The individualized DSA indirect portography procedure is chosen according to the condition of portal vein and collateral vessels before TIPS.The larger the internal meridians of the main portal vein and the collateral vessels are,the worse the indirect portography is.