三维路图在经颈静脉门体分流术中导引门静脉穿刺的应用价值

The application of three-dimensional roadmap in guiding puncture of portal vein during the performance of transjugular intrahepatic portosystemic shunt

目的 比较经颈静脉门体分流术(TIPS)中三维路图和常规间接门静脉造影引导门静脉穿刺的效果。方法 回顾性分析2018年4月至2021年2月连续121例接受TIPS治疗患者临床资料。根据TIPS术中门静脉穿刺导引方式分为三维路图组(研究组,n=42)、常规间接门静脉造影组(对照组,n=79)。采用Mann-Whitney检验分析两组患者间技术/血流动力学成功率,门静脉穿刺次数、穿刺时间、X线透视剂量,成像辐射剂量及图像质量的差异;Kendall’s tau-b相关系数分析图像质量相关性。结果 两组患者基线差异均无统计学意义(P>0.05)。两组技术成功率和血流动力学成功率均为100%。两组门静脉穿刺针数、穿刺时间、透视剂量、穿刺相关并发症差异均无统计学意义(P=0.30、0.61、0.55、1.00)。研究组门静脉成像辐射剂量(63.1±23.3) Gy/cm2低于对照组(209.9±49.5) Gy/cm2(P>0.01)。研究组与对照组门静脉图像质量差异有统计学意义(P=0.04)。研究组(tau-b=0.79,P<0.01)、对照组(tau-b=0.71,P<0.01)图像质量,均与门静脉穿刺导引效果呈显著正相关。对照组图像质量与穿刺透视剂量呈负相关(tau-b=-0.2,P=0.02)。结论 三维路图和常规间接门静脉造影均能成功导引TIPS术中门静脉穿刺,但三维路图导引辐射剂量更低,可有效减少患者所受射线辐射。

Objective To compare the effect of three-dimensional(3-D) roadmap-guided portal vein puncture with that of conventional indirect portal venography-guided portal vein puncture in performing transjugular intrahepatic portosystemic shunt(TIPS).Methods The clinical data of 121 consecutive patients,who received TIPS between April 2018 and February 2021,were retrospectively analyzed.According to the guiding method of portal vein puncture,the patients were divided into study group(n=42,guided by 3-D roadmap)and control group(n=79,guided by conventional indirect portography).Mann-Whitney testing was used to evaluate the technical and hemodynamic success rate,the number of portal vein punctures,the time spent for puncture,the fluoroscopic radiation dose,the imaging radiation dose and image quality.The results were compared between the two groups.Kendall’s tau-b correlation coefficient was used to analyze the correlation of image quality.Results No statistically significant differences in the baseline data existed between the two groups(P>0.05).The technical and hemodynamic success rate was 100% in both groups.There were no statistically significant differences in the number of portal vein punctures(P=0.30),time spent for puncture(P=0.61),fluoroscopic radiation dose(P=0.55),puncture-related complications(P=1.00) between the two groups.The radiation dose of portal vein imaging in the study group was(63.1±23.3) Gy/cm2,which was remarkably lower than(209.9±49.5) Gy/cm2in the control group(P<0.001).The image quality of portal vein in the study group was prominently better than that in the control group,the difference between the two groups was statistically significant(P=0.04).The image quality in both of the study group(tau-b=0.79,P<0.01) and the control group(tau-b=0.71,P<0.01) was positively correlated with the guiding effect of portal vein puncture.The image quality in the control group was negatively correlated with the fluoroscopic radiation dose of puncturing(tau-b=-0.2,P=0.02).Conclusion Both 3-D roadmap and conventional indirect portography can successfully guide the puncture of portal vein in TIPS,but the radiation dose of 3-D roadmap-guided puncturing is lower,which can effectively reduce the radiation dose received by the patient.(J Intervent Radiol,2022,31:346-350)