组织结构声学定量技术无创评估TIPS联合PTVE疗效

发布时间：2018-01-29 16:09

本文关键词： 经颈静脉肝内门体分流术经皮肝穿胃冠状静脉栓塞术组织结构声学定量　出处：《重庆医科大学学报》2015年08期 　论文类型：期刊论文

【摘要】：目的:探讨组织结构声学定量分析(acoustic structure quantification,ASQ)技术在无创评价经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)联合经皮肝穿胃冠状静脉栓塞术(percutaneous transhepatic varices embolization,PTVE)疗效的临床应用价值。方法:应用ASQ技术对30例正常人及30例肝硬化门静脉高压预行TIPS联合PTVE患者手术前后肝、脾分别定量分析,比较手术前后肝、脾的ASQ卡方值直方图和ASQ定量相关参数:众数、均值、标准差以及蓝红2色直方图曲线下面积比;并在手术过程中测量门静脉压(portosystemic pressure gradient,PPG);比较手术前后肝、脾ASQ定量参数值的变化及与PPG的相关性。结果:PPG术前组(28.71±4.81)mm Hg与术后组(18.30±4.73)mm Hg比较,差异具有统计学意义(P0.05);脾脏Red Mode、Red Ave、Red SD、FD ratio、Blue Mode、Blue Ave、Blue SD各参数值正常对照组分别为(99.60±2.15)、(102.25±2.22)、(13.62±1.70)、(0.13±0.11)、(120.90±6.29)、(132.57±15.98)、(27.94±13.65),术前组上述参数值分别为(103.21±1.98)、(107.52±2.51)、(18.48±1.41)、(0.18±0.07)、(125.25±2.86)、(146.57±9.03)、(37.64±10.21),术前组脾ASQ各定量参数均大于正常对照组(P0.05);术后组脾ASQ各定量参数分别为(101.66±1.97)、(105.24±2.04)、(16.56±1.49)、(0.15±0.09)、(122.96±5.56)、(137.96±14.46)、(31.45±12.49),术后各参数值均小于术前,各组之间具有统计学差异(P0.05);肝ASQ各定量参数值在术前组分别为(117.81±3.23)、(120.70±3.27)、(19.70±1.07)、(0.67±0.28)、(136.05±4.62)、(148.68±7.03)、(33.68±7.36),术后组各参数值分别为(118.01±3.35)、(120.9±3.58)、(19.54±1.40)、(0.66±0.30)、(135.26±4.38)、(148.42±7.65)、(33.73±6.30),术前组与术后组比较差异无统计学意义(P0.05)。脾ASQ各定量参数值与PPG呈高度正相关(r值分别为0.299、0.331、0.451、0.848、0.961、0.318、0.881,P均0.05);然而肝ASQ各定量参数值与PPG无相关性(r值分别为0.194、0.174、0.045、0.169、0.128、0.105、0.136,P均0.05);正常对照组、术前组、术后组脾脏指数(spleen index,SI)分别为(18.21±1.42)cm2、(45.23±12.32)cm2、(35.66±11.70)cm2,正常对照组与术前、术前组与术后组脾指数比较差异均有统计学意义(P0.05)。结论:ASQ技术测量的脾ASQ各定量参数值可用于无创定量监测TIPS联合PTVE术前、术后门静脉压的变化情况、评价手术疗效,具有良好的临床应用前景。
[Abstract]:Objective: to study the acoustic quantitative analysis of structure quantification in tissue structure. The transjugular intrahepatic portosystemic shunt was evaluated by transjugular intrahepatic portosystemic shunt. Transhepatic varices embolization combined with percutaneous transhepatic gastric coronary vein embolization. Methods: 30 normal subjects and 30 cirrhotic patients with portal hypertension pretreated with TIPS combined with PTVE were treated with ASQ before and after operation. Before and after operation, the ASQ chi-square value histogram and ASQ quantitative correlation parameters of liver and spleen were compared: mode, mean value, standard deviation and area ratio under blue red 2-color histogram curve. The portal vein pressure was measured in the course of operation. The liver was compared before and after operation. Changes of spleen ASQ quantitative parameters and their correlation with PPG. Results the preoperative group (28.71 卤4.81 mm Hg) and the postoperative group (18.30 卤4.73). Mm Hg. The difference was statistically significant (P 0.05). The spleen Red modea Red Avee Red SDX FD modeo blue Ave. The parameters of Blue SD in normal control group were 99.60 卤2.15, 102.25 卤2.22 and 13.62 卤1.70, respectively. (0.13 卤0.11). 90 卤6.29 (132.57 卤15.98) (27.94 卤13.65). The above parameters in the preoperative group were 103.21 卤1.98, 107.52 卤2.51, 18.48 卤1.41, 0.18 卤0.07, respectively. The quantitative parameters of splenic ASQ in the preoperative group were higher than those in the normal control group (P 0.05). The quantitative parameters of splenic ASQ in postoperative group were 101.66 卤1.97, 105.24 卤2.04, 16.56 卤1.49, 0.15 卤0.09, respectively. The postoperative parameters were lower than those before operation (137.96 卤14.46) and 31.45 卤12.49 (P < 0.05). There was statistical difference between each group (P 0.05). The quantitative parameters of liver ASQ in the preoperative group were 117.81 卤3.23, 120.70 卤3.27, 19.70 卤1.07 and 0.67 卤0.28, respectively. The parameters of the postoperative group were 118.01 卤3.35). 0.66 卤0.30, 135.26 卤4.38, 148.42 卤7.65). There was no significant difference between the preoperative group and the postoperative group (P 0.05). There was a high positive correlation between the quantitative parameters of splenic ASQ and PPG (r = 0.299). 0.331U 0.451U 0.848U 0.961U 0.318g 0.881g P 0.05g; However, there was no correlation between the quantitative parameters of liver ASQ and PPG (r = 0.194 0.174 0. 049 0. 169) and 0. 128 0. 105 (0.136). P = 0.05; The spleen index of normal control group, preoperative group and postoperative group were 18.21 卤1.42 cm ~ 2 and 45.23 卤12.32 cm ~ 2, respectively. 35. 66 卤11.70 cm ~ 2, normal control group and preoperative. There were significant differences in spleen index between preoperative group and postoperative group (P 0.05). Conclusion the quantitative parameters of splenic ASQ measured by the technique of 10% ASQ can be used for noninvasive quantitative monitoring of TIPS combined with PTVE before operation. The change of portal vein pressure after operation and the evaluation of operative effect have good clinical application prospect.
【作者单位】：重庆医科大学超声影像学研究所;重庆市渝中区疾病预防控制中心传染病防治科;重庆医科大学附属第二医院放射科;重庆医科大学附属第二医院消化内科;
【基金】：国家自然科学基金资助项目(编号:81271598,81270021) 教育部科学技术研究重点资助项目(编号:[2012]76) 重庆市教委科学技术研究重点资助项目(编号:KJ120328) 重庆市杰出青年基金资助项目(编号:cstc2013jcyjjq10004)
【分类号】：R445.1
【正文快照】： 经颈静脉肝内门体静脉分流术(transjugular in-trahepatic portosystemic shunt,TIPS)联合经皮肝穿胃冠状静脉栓塞术(percutaneous transhepatic varicesembolization,PTVE),既能有效降低门静脉压(por-tosystemic pressure gradient,PPG),又能控制并预防食管胃底静脉曲张破裂

【参考文献】