肝硬化PHT经颈内静脉肝内门体分流术前后的肝CT类灌注成像研究

doi:10.13418/j.issn.1001-165x.2023.2.20

PDF(2381 KB)

中国临床解剖学杂志 ›› 2023, Vol. 41 ›› Issue (2) : 234-239. DOI: 10.13418/j.issn.1001-165x.2023.2.20

临床研究

肝硬化PHT经颈内静脉肝内门体分流术前后的肝CT类灌注成像研究

李斯锐，吴宁，黄渭，卢先明，马明昭

作者信息 +

Hepatic CT perfusion imaging of PHT in cirrhotic patients before and after transjugular intrahepatic portosystemic shunt

Li Sirui, Wu Ning, Huang Wei, Lu Xianming, Ma Mingzhao

Author information +

文章历史 +

摘要

目的探讨肝硬化门静脉高压（Portal hypertension，PHT）患者行经颈内静脉肝内门体分流术前、后肝CT类灌注成像的应用价值。方法回顾2018年1月至2020年1月我院行经颈内静脉肝内门体分流术治疗的肝硬化PHT患者62例，收集术前、术后的CT扫描图像，计算经颈内静脉肝内门体分流术前后肝动脉、门脉类灌注，分析CT灌注参数的差异；根据治疗效果分组，计算各组AEF值；收集患者术前、后的血清检查结果，并计算患者MELD评分。结果肝硬化PHT患者术后的肝动脉灌注、动脉灌注指数较术前有显著的提高（P<0.05），肝门静脉灌注术前、术后差异不大。患者术后动脉增强分数上升，和术前值具有统计学差异（P<0.05）。术后终末期肝病模型评分增加，和术前比较具有统计学差异（P<0.05）。结论肝CT类灌注成像能够反映肝硬化PHT患者行经颈内静脉肝内门体分流术前、后的肝微循环变化；行经颈内静脉肝内门体分流术不会使患者肝功能恶化好转。

Abstract

Objective To investigate the application value of CT perfusion imaging in liver cirrhosis patients with portal hypertension (PHT) before and after transjugular intrahepatic portosystemic shunt. Methods A retrospective analysis of 62 patients with PHT of liver cirrhosis who underwent transjugular intrahepatic portosystemic shunt in our hospital from January 2018 to January 2020 was performed. The CT images before and after transjugular intrahepatic portosystemic shunt was collected. The perfusion of hepatic artery and portal vein before and after the intrahepatic portal shunt of internal jugular vein were calculated to analyze the differences of CT perfusion parameters . Then, according to the treatment effect, the AEF values of each group were calculated. The serum examination results before and after operation were collected, and the MELD score of patients was calculated. Results The HAP and HPI of patients after operation were significantly improved compared with those before operation. There was no significant difference in hepatic portal vein before and after operation. There were statistically significant differences in several perfusion parameters before and after operation (P<0.05). AEF increased after operation, and the difference was statistically significant (P<0.05).The MELD value of PHT patients with liver cirrhosis increased after operation, and the difference was statistically significant compared with that before operation (P<0.05). Conclusions Hepatic CT perfusion imaging can reflect the changes of hepatic microcirculation before and after transjugular intrahepatic portosystemic shunt in PHT patients with liver cirrhosis, and transjugular intrahepatic portosystemic shunt does not worsen the liver function.

导出引用

李斯锐, 吴宁, 黄渭, 卢先明, 马明昭. 肝硬化PHT经颈内静脉肝内门体分流术前后的肝CT类灌注成像研究[J]. 中国临床解剖学杂志. 2023, 41(2): 234-239 https://doi.org/10.13418/j.issn.1001-165x.2023.2.20

Li Sirui, Wu Ning, Huang Wei, Lu Xianming, Ma Mingzhao. Hepatic CT perfusion imaging of PHT in cirrhotic patients before and after transjugular intrahepatic portosystemic shunt[J]. Chinese Journal of Clinical Anatomy. 2023, 41(2): 234-239 https://doi.org/10.13418/j.issn.1001-165x.2023.2.20

中图分类号： R575

参考文献

[1] 李安源, 高兵红, 张金玲, 等. CT灌注成像在兔早期肝硬化诊断中的应用价值研究[J]. 现代生物医学进展, 2019, 19(4): 626-630. DOI: 10.13241/j.cnki.pmb.2019.04.005.
[2] Valentin N, Weisberg I. The role of transjugular intrahepatic portosystemic shunt in the management of portal vein thrombosis[J]. Eur J Gastroenterol Hepatol, 2019, 31(3): 403-404. DOI: 10.1016/S0168-8278(18)31706-9.
[3] Nelson V, Praneet K, Joseph C, et al. 361-The role of transjugular intrahepatic portosystemic shunt in the management of portal vein thrombosis: a systematic review and meta-analysis[J]. Eur J Gastroenterol Hepatol, 2018, 154(6): S1086-S1087.
[4] 刘美兰, 杜兆峰, 薄健, 等. 16层螺旋CT灌注成像对肝硬化血流状态的评估及与肝硬化程度的相关性研究[J]. 现代生物医学进展, 2018, 18(14): 2714-2717. DOI: 10.1016/s0016-5085(18)33622-9.
[5] 郭胜珺, 唐少珊. 超声成像在经颈内静脉肝内门体分流术中的应用研究进展[J]. 中国医学影像技术, 2019, 35(11): 1748-1751. DOI: 10.13929/j.1003-3289.20190501.
[6] Esfeh JM, Ansari-Gilani K. Transjugular intrahepatic portosystemic shunt in cirrhotic patients with portal vein thrombosis[J]. Eur J Gastroenterol Hepatol, 2020,32(6):762-763. DOI:10.1097/MEG. 00000 00000001680.
[7] 陈俊邦, 李健, 梁俊迪, 等. 经颈静脉肝内门体分流术治疗肝硬化门静脉高压症临床研究[J]. 实用肝脏病杂志, 2019, 22(2): 82-85. DOI: 10.3969/j.issn.1672-5069.2019.02.019.
[8] Xue X, Hui H, Bo W, et al. Su1088-gut microbiota changes in cirrhosis patients with transjugular intrahepatic portosystemic shunt (TIPS)[J]. Gastroenterology, 2019, 156(6): S1272-S1273. DOI: 10.1016/S0016-5085(19)40185-6.
[9] 李素萍, 薛迪强, 丁光荣. CT门脉成像联合内镜超声指导肝硬化食管胃底静脉曲张精准治疗的随机对照研究[J]. 中华消化内镜杂志, 2018, 35(9): 644-649. DOI: 10.3760/cma.j.issn.1007-5232.2018.09.009.
[10]Riccardo, Inchingolo A, Posa M, et al. Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: a comprehensive review[J]. World J Gastroenterol, 2020, 26(34): 5-18. DOI: 10.3748/wjg.v26.i34.5060.
[11] Kraglund F, Jepsen P, Amanavicius N, et al. Long-term effects and complications of the transjugular intrahepatic portosystemic shunt: a single-centre experience[J]. Scand J Gastroenterol, 2019, 54(7): 1-6. DOI: 10.1080/00365521.2019.1630675.
[12] 刘倩倩, 董国礼, 敬宗林, 等. 肝硬化对胰腺微循环影响的CT灌注成像研究[J]. 实用放射学杂志, 2018, 31(4): 42-46. DOI: 10.3969/j.issn.1002-1671.2018.01.012.
[13] Leng X, Zhang F, Zhang M, et al. Comparison of transjugular intrahepatic portosystemic shunt for treatment of variceal bleeding in patients with cirrhosis with or without spontaneous portosystemic shunt[J]. Eur J Gastroenterol Hepatol, 2019, 31(7): 853-858. DOI: 10.1097/MEG.0000000000001349.
[14] 崔毛毛, 翟亚楠, 高玉岭, 等. AEF值评估肝硬化门静脉高压TIPS术疗效的应用价值[J]. 临床放射学杂志, 2020, 39(1): 79-82. CNKI: SUN:LCFS.0.2020-01-019.
[15] Michelle P, Bartley T. Preoperative transjugular intrahepatic portosystemic shunt placement for extrahepatic abdominal surgery[J]. Semin Intervent Radiol, 2018, 35(3): 203-205. DOI: 10.1055/s-0038-1660799.
[16] 赵旭, 纪凤颖, 常燃, 等. 肝CT灌注成像技术在肝脏肿瘤应用现状、存在的问题及展望[J]. 现代生物医学进展, 2018, (4): 797-800. DOI: 10.13241/j.cnki.pmb.2018.04.045.
[17] 王磊, 王文卿. 经颈静脉肝内门体分流术治疗老年肝硬化门静脉高压症的疗效及对血流动力学的影响[J]. 临床外科杂志, 2018, 26(1): 47-50. DOI: 10.3969/j.issn.1005-6483.2018.01.015.
[18] 周轩, 鄢晓龙. 原发性肝癌患者TACE治疗前后CT全肝灌注成像的表现[J]. 西南国防医药, 2018, 28(9): 69-71. DOI: 10.3969/j.issn.1004-0188.2018.09.023.
[19] Schmitz A, Haste P, Johnson MS. Transjugular intrahepatic portosystemic shunt (TIPS) creation prior to abdominal operation: a retrospective analysis[J]. J Gastrointest Surg, 2020, 24(10): 2228-2232. DOI: 10.1007/s11605-019-04384-w.
[20] Buechter M, Manka P, Gerken G, et al. Transjugular intrahepatic portosystemic shunt in patients with portal hypertension: patency depends on coverage and interventionalist's experience[J]. Dig Dis, 2018, 36(3): 218-227. DOI: 10.1159/000486030.
[21] 陆舜钦, 李彦, ,管竹春, 等. CT/MRI融合图像在肝癌介入治疗术后疗效评估中的应用[J]. 肝脏, 2020, 25(7): 114-115. CNKI: SUN:ZUAN.0.2020-07-034.
[22] Bucsics T, Schoder M, Mandorfer M, et al. SAT-020-Transjugular intrahepatic portosystemic shunt implantation improves renal function in patients with ascites[J]. J Hepatolo, 2019, 70(1): e633-e634. DOI: 10.1016/S0618-8278(19)31263-0.
[23] 石朋, 王坤, 沈俊春, 等. CT检查在原发性肝癌患者经肝动脉化疗栓塞术后疗效评估中的应用价值分析[J]. 实用肝脏病杂志, 2018, 21(2): 106-109. DOI: 10.3969/j.issn.1672-5069.2018.02.024.
[24] H Zhao, Yue Z, Wang L, et al. Benefits of early treatment for patients with hepatic myelopathy secondary to TIPS: a retrospective study in northern China[J]. Sci Rep, 2018, 8(1): 15184-15192. DOI: 10.1038/s41598-018-33216-1.