超声在经颈内静脉肝内门体分流术术后评估的应用价值

发布时间：2018-06-11 14:32

本文选题：超声 + TIPS术后　；参考：《青海大学》2017年硕士论文

【摘要】：目的:经颈内静脉肝内门体分流术(TIPS)能有效降低门脉压力,缓解临床症状,但术后远期并发症较常见,如支架内狭窄、闭塞、血栓等。超声能够无创、有效、反复多次检测TIPS术后门静脉及支架内血流情况,探讨超声评估TIPS术后的应用价值。方法:收集2013年3月至2016年9月符合要求行TIPS术后的门脉高压症患者(PHT),于术前、术后一周、一个月、六个月超声测量门静脉内径、最大血流速度及分流道最大血流速度,并计算门静脉血流量(Q)、门静脉充血指数(CI),观测门静脉相应的血流参数变化值。随后每六个月随访一次,观察每位患者在整个随访期间分流道有无功能障碍(狭窄或闭塞),记录发生的例数,然后与数字减影血管造影(DSA)对比,评价超声诊断分流道狭窄、闭塞的准确率。结果:TIPS术后门静脉内径术前与术后不同时间随访相互对比无明显差异。门静脉最大血流速度、血流量术后不同时间随访记录较术前增快(P0.05)。门静脉最大血流速度、血流量及分流道内最大血流速度术后六个月较术后一个月、一周减慢(P0.05),术后一周与一个月对比无明显差异。门静脉CI在TIPS术后较术前明显下降,术后不同时间相互之间对比无差异。超声在整个定期随访过程中诊断分流道障碍次数为25例,经DSA证实,25例均为分流道内功能障碍,其中分流道内狭窄为14例,分流道内闭塞为11例,诊断分流道狭窄准确率为85.71%,闭塞准确率为90.91%。结论:超声能够无创、反复多次测量TIPS术后门静脉及分流道内血流情况,并能及时评价术后支架内功能状态,从而成为TIPS术后首选的一种方法。
[Abstract]:Objective: Transjugular intrahepatic portosystemic shunt (TIPS) can effectively reduce portal pressure and relieve clinical symptoms, but long-term complications are common, such as stent stenosis, occlusion, thrombus and so on. Ultrasound can be noninvasive, effective and repeated to detect portal vein and intrastent blood flow after tips, and to evaluate the value of ultrasound in evaluating postoperative tips. Methods: portal hypertension patients with portal hypertension were collected from March 2013 to September 2016. The diameter of portal vein, the maximum flow velocity and the maximum flow velocity of shunt were measured by ultrasound before operation, one week, one month and six months after operation. The portal vein blood flow and portal hyperemia index were calculated and the blood flow parameters of portal vein were measured. Each patient was followed up every six months to observe whether each patient had dysfunction of the shunt (stenosis or occlusion, record the number of cases occurring, and then compare it with digital subtraction angiography (DSAs) to evaluate the diagnosis of shunt stenosis by ultrasound. Block accuracy. Results there was no significant difference in the diameter of portal vein between preoperative and postoperative follow-up. The maximum blood flow velocity of portal vein and blood flow in different time after operation were more rapid than those before operation (P 0.05). The maximum portal vein blood flow velocity, blood flow volume and the maximum blood flow velocity in the shunt tract were significantly lower in six months than in one month after operation, but there was no significant difference between one week and one month after operation. The CI of portal vein decreased significantly after tips, but there was no difference between them at different time. During the whole period of regular follow-up, 25 cases of shunt obstruction were diagnosed by ultrasonography, and 25 cases were confirmed by DSA. Among them, 14 cases were stenosis of shunt pathway and 11 cases were occluded in shunt pathway. The diagnostic accuracy of shunt stenosis and occlusion were 85.71 and 90.91 respectively. Conclusion: ultrasound can measure the blood flow of portal vein and shunt channel repeatedly and repeatedly after tips, and can evaluate the functional status of stent in time, so it is the first choice method after tips.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2

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