摘要
目的探讨经颈静脉肝内门腔分流术(TIPSS)后肝血流的变化情况以及两者之间的关系。方法对9例因肝硬化而实施 TIPSS 的患者术前1周、术后72 h 进行 CT 灌注扫描,并在分流通道建立前、后进行门静脉测压。其中3例患者在术后3个月和6个月复查了 CT 灌注扫描成像。所有患者在术后48 h 内进行了 Doppler 超声检查,并于术后3个月(9例)和6个月(6例)行 Doppler 超声复查。2例患者在术后6个月进行了 TIPSS 支架造影和门静脉测压。结果全部患者术前门静脉灌注量(PVP)为(0.92±0.18)ml·min^(-1)·ml^(-1),总灌注量(THBF)为(1.28±0.17)ml·min^(-1)·ml^(-1),动脉灌注指数(HPI)为(28±8)%,门静脉自由压(PVFP)为(23.92±0.86)mm Hg(1 min Hg=0.133 kPa);术后72 h 测得 PVP 为(0.21±0.15)ml·min^(-1)·ml^(-1),THBF 为(0.74±0.18)ml·min^(-1)·ml^(-1),HPI 为(74±13)%,PVFP 为(12.62±1_54)mm Hg;术后3个月和6个月 PVP 分别为(0.49±0.05)ml·min^(-1)·ml^(-1)和(0.57±0.03)ml·min^(-1)·ml^(-1);术前 PVP 与 PVFP 之间存在负相关(r=0.678,P<0.05),术后 PVP 与 PVFP 之间无线性相关性(r=0.543,P>0.05),TIPSS 导致PVFP 平均值下降梯度与门静脉灌注减少量之间存在正相关(r=0.867,P<0.01)。Doppler 超声监测TIPSS 术后48 h 肝门静脉血流情况:主干为(27.9±3.4)cm/s,支架内为(62.6±6.4)cm/s;肝内门静脉分支均为出肝血流,门静脉左支(18.9±7.2)cm/s、右支为(6.6±3.2)cm/s。术后6个月主干为(15.6±1.1)cm^3/s,支架(9.8±5.7)cm^3/s。结论 TIPSS 术后 PVFP 平均值下降的同时伴有大量门静脉血流成为无效灌注,无效 PVP 与 PVFP 平均值下降直接相关。肝动脉无法代偿门静脉有效灌注量的下降。
Objective To evaluate hemodynamic changes in liver treated by transjugular intrahepatic portosystemic stent-shunt （TIPSS） with hepatic computed tomography （CT） perfusion, Doppler ultrasound and portal vein pressure measurement, as well as the correlation among these methods. Methods Hepatic CT perfusion was performed in 9 cirrhotic patients one week before TIPSS and 72 hours after TIPSS. Intraoperative portal vein pressure was measured before and after portosystemic shunt establish. The follow- up hepatic CT perfusion were carried out in 3 cases at 3 months and 6 months postoperatively. The hemodynamic surveillance by Doppler ultrasound were performed in 48 hours and 3 months after TIPSS for 9 cases, and in 6 months after TIPSS for 6 cases. Two cases underwent venography and portal vein pressure measurement in 6 months after TIPSS treatment. Results The mean of portal vein perfusion （ PVP）, total hepatic blood flow （THBF） , hepatic perfusion index （HPI） and portal vein free pressure （PVFP） before TIPSSwere （0.92±0.18）ml·min^-1·m1^-1, （1.28±0.17）ml·min^-1·m1^-1, （28 ±8） %, and （23.92 ± 0. 86） mmHg, respectively. In 72 hours after TIPSS, the mean of PVP, THBF, HPI and PVFP were （0.21 ±0.15）ml·min^-1·m1^-1, （0.74 ±0.18） ml·min^-1·m1^-1, （74 ± 13） %, and （ 12. 62 ± 1.54） mm Hg, respectively. After treatment, the mean of PVP was （0. 49 ±0. 05 ） ml·min^-1·m1^-1 at 3 months and （0.57 ±0.03） ml·min^-1·m1^-1 at 6 months, respectively. There was negative correlation between PVP and PVFP before TIPSS （ r = 0. 678, P 〈 0. 05 ）, but there was no correlation between them after TIPSS （ r = 0. 543, P 〉 0. 05 ）. Moreover, a significant correlation was found between the degree of portal vein pressure decrease and portal vein perfusion decrease （ r = 0. 867, P 〈 0. 01 ）. In addition, the mean of blood flow rate （BFR） of portal vein detected by Doppler ultrasound after TIPSS in 48 hours were as follows ： （ 27.9 ± 3.4 ） cm/s for the main portal vein, （ 62. 6 ± 6.4 ） cm/s for the within stent, （ 18.9 ± 7.2） cm/s for the left branch of portal vein, （6. 6 ± 3.2） cm/s for the fight branch of portal vein, respectively. The mean of blood flow of stent （ 15.6 ± 1.1 ） cm^3/s was not less than that of main portal vein （9. 83 ± 5. 72 ） cm^3/s until six months after treatment. Conclusion The portal vein pressure obviously decreased after TIPSS, and meanwhile, most blood flow of portal vein passed through portosystemic stent shunt without liver parenchyma perfusion. Moreover, the more the portal vein pressure decreased, the more the inefficient blood flow of portal vein was. Hepatic arterial perfusion could not balance the decrease of efficient PVP.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2007年第12期1374-1378,共5页
Chinese Journal of Radiology
基金
国家自然科学基金(30270417)
广东省医学科研课题项目(B2006025)
