CT门静脉成像与内镜在肝硬化患者急诊经颈静脉肝内门体分流术前评估中的价值研究

Computed tomography portal venography versus endoscopy in preoperative evaluation of cirrhosis patients undergoing emergency transjugular intrahepatic portosystemic shunt

目的评价CT门静脉成像(CTPV)对比内镜在肝硬化食管胃静脉曲张出血(EGVB)患者急诊经颈静脉肝内门体分流术(em-TIPS)前评估中的价值。方法回顾性分析2016年7月1日至2019年6月30日在苏州大学附属第一医院接受em-TIPS术治疗的82例急性EGVB患者临床资料。分析CTPV与DSA诊断食管胃静脉曲张(EGV)分型、CTPV与术前内镜诊断EGV分型和分级的一致性。结果 82例成功完成em-TIPS术。其中80例(97.6%)术后成功止血,2例术后发生再出血。CTPV与DSA诊断EGV分型完全一致:GOV1型55例,GOV2型21例,IGV1型6例。23例患者接受术前内镜检查,CTPV与术前内镜诊断EGV分型、分级结果的一致性均较高,Kappa值分别为0.79、0.78,均P<0.001。结论肝硬化急性EGVB患者em-TIPS术前接受CTPV评估可行且有效,可作为无法或无条件行急诊内镜检查和治疗患者术前评估的替代方法。

Objective To investigate the clinical value of computed tomography portal venography(CTPV)in preoperative evaluation of emergency transjugular intrahepatic portosystemic shunt(em-TIPS) for cirrhosis patients complicated by acute esophagogastric variceal bleeding(EGVB), and to compare the clinical value of CTPV with that of endoscopy. Methods The clinical data of 82 cirrhosis patients complicated by acute EGVB, who were admitted to the First Affiliated Hospital of Soochow University of China to receive emTIPS between July 1, 2016 and June 30, 2019, were retrospectively analyzed. The consistency between CTPV and digital subtraction angiography(DSA) in diagnosing the typing of EGV as well as the consistency between CTPV and preoperative endoscopy in diagnosing the typing and grading of EGV were analyzed.Results Successful em-TIPS was accomplished in all the 82 patients, of them 80(97.6%) obtained successful hemostasis and 2 developed rebleeding. CTPV was fully consistent with DSA in diagnosing EGV typing, the results of which were as follows: GOV1 type was seen in 55 patients, GOV2 type in 21 patients, and IGV1 type in 6 patients. Twenty-three patients received preoperative endoscopy. In diagnosing the typing and grading of EGV, CTPV showed higher consistency with preoperative endoscopy, and the Kappa values were 0.79 and0.78 respectively(P<0.001). Conclusion In treating cirrhosis patients associated with acute EGVB by using em-TIPS therapy, the use of CTPV to make preoperative evaluation is feasible and effective. It can be used as an alternative method of making preoperative evaluation for the patients who are unable to, or impossible to,receive emergency endoscopy.(J Intervent Radiol, 2021, 30: 1025-1028)