实时三维超声血管成像在经颈静脉肝内门体分流术前的应用价值

发布时间：2018-04-18 04:19

本文选题：实时三维超声 + 经颈静脉肝内门体分流术　；参考：《西部医学》2017年04期

【摘要】：目的探讨实时三维超声(RT 3D-US)在经颈静脉肝内门体分流术(TIPS)前血管成像中的应用价值。方法 30例肝硬化门静脉高压合并上消化道出血或大量腹水行TIPS的患者,术前应用实时三维超声行肝内血管成像,明确肝右静脉和门静脉右支的空间走行关系,选取穿刺位点、测量穿刺角度和二者间的距离以及了解有无肝包膜包裹。结果 RT 3D-US彩色血流成像可以实现对肝内门静脉、肝右静脉走行及空间关系的直观显示,矢状面观肝右静脉距下腔静脉开口2cm处与门静脉右支的平均距离为(3.8±1.3)cm,平均角度为(39.1±8.3)°。运用RT 3D-US多平面成像技术可以确定门静脉周围是否有肝组织及肝包膜,并提示裸露的部位。根据术前RT 3D-US血管成像制定穿刺路径和角度,术中一次穿刺成功26例(86.7%),2次穿刺成功4例(13.3%),术中未出现严重并发症。结论应用无创RT 3DUS可以直观再现肝硬化患者肝内血管的空间走行及相互关系,有助于指导TIPS术前制定手术方案,减少穿刺并发症,可在临床推广应用。
[Abstract]:Objective to evaluate the value of real-time three-dimensional ultrasonography (RT3 D-USS) in the diagnosis of intrahepatic portal shunt via jugular vein before TIPS angiography.Methods Thirty patients with cirrhotic portal hypertension complicated with upper gastrointestinal hemorrhage or massive ascites were performed intrahepatic vascular imaging with real-time three-dimensional ultrasound before operation. The spatial relationship between the right hepatic vein and the right portal vein was determined, and the puncture site was selected.The angle of puncture and the distance between them were measured.Results RT 3D-US color flow imaging could visualize the intrahepatic portal vein, the right hepatic vein and the spatial relationship. The average distance between the sagittal view of the right hepatic vein and the right branch of the portal vein was 3.8 卤1.3 cm and the average angle was 39.1 卤8.3) 掳between the right hepatic vein and the right branch of the portal vein from the inferior vena cava to the opening of the inferior vena cava on the sagittal plane.RT 3D-US multiplanar imaging can be used to determine whether there is liver tissue and hepatic capsule around the portal vein, and to indicate the exposed location.According to the preoperative RT 3D-US angiography, 26 cases were successful in one puncture and 4 cases were successful in 2 times. There were no serious complications during the operation.Conclusion the application of noninvasive RT 3DUS can visualize the spatial movement and interrelation of intrahepatic blood vessels in patients with liver cirrhosis, which is helpful to guide the preoperative operation of TIPS, reduce the complications of puncture, and can be popularized in clinical practice.
【作者单位】：成都中医药大学附属医院超声医学科;成都中医药大学附属医院血管外科;
【基金】：成都中医药大学基金支持项目(ZRMS201207)
【分类号】：R445.1;R657.3

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