摘要
目的分析影像融合技术引导经颈静脉肝内门体分流(TIPS)术中穿刺门静脉的可行性。方法回顾性分析41例接受TIPS治疗的肝硬化食管胃底静脉曲张破裂出血(EGVB)患者。对其中18例以影像融合技术引导穿刺门静脉(融合组),融合术前门静脉增强CT图像和术中腹部Xper-CT图像后,重建3D门静脉图像作为3D路径图,以之引导穿刺;对23例于常规DSA引导下进行穿刺(常规组)。对比组间穿刺次数、穿刺时间、辐射剂量及对比剂用量;测量并比较融合3D路径图与直接门静脉造影图像中的门静脉主干纵向和横向误差。结果2组均经由肝静脉成功穿刺门静脉左支并成功施行TIPS,术中及术后均未出现严重并发症。融合组穿刺次数、穿刺时间、辐射剂量及对比剂用量均低于常规组(P均<0.01)。3D路径图与直接门静脉造影图像之间的门静脉纵向误差为0~9 mm(中位误差2.35 mm),横向误差0~9 mm(中位误差1.50 mm)。融合组18例中,10例(10/18,55.56%)门静脉纵向误差小,5例(5/18,27.78%)纵向误差一般,3例(3/18,16.67%)纵向误差较大;13例(13/18,72.22%)门静脉横向误差小,4例(4/18,22.22%)横向误差一般,1例(1/18,5.56%)横向误差较大。结论影像融合技术引导TIPS术中穿刺门静脉安全、可行。
Objective To analyze the feasibility of image fusion technique for guiding portal vein puncture during transjugular intrahepatic portosystemic shunt(TIPS).Methods A total of 41 patients with liver cirrhosis complicated with esophageal and gastric variceal bleeding(EGVB)underwent TIPS.Image fusion technique was used to guide portal vein puncture in 18 cases(fusion group),preoperative portal enhanced CT images and intraoperative abdominal Xper-CT images were fused,and 3D image of portal vein was reconstructed as the 3D path map to guide the puncture,whereas routine DSA guided puncture of portal vein was performed in other 23 cases(conventional group).The times of portal vein puncture,puncture time,radiation dose and dosage of contrast agent were compared between groups.Then the longitudinal and lateral errors of the main portal vein were measured and compared between the fused 3D path map and the direct portal contrast image.Results In both groups,the left branch of portal vein was successfully punctured from hepatic vein,and TIPS was all successfully performed.No serious complication occurred during and after TIPS procedures.The times of puncture,puncture time,radiation dose and dosage of contrast agent of fusion group were shorter or lower than those of conventional group(all P<0.01).The longitudinal error of portal vein between fused 3D path map and the direct portal contrast image was 0-9 mm(median error 2.35 mm),and the lateral error was 0-9 mm(median error 1.50 mm).Among 18 cases in fusion group,the longitudinal error was small in 10(10/18,55.56%),moderate in 5(5/18,27.78%)but large in 3 cases(3/18,16.67%);while the lateral error was small in 13 cases(13/18,72.22%),moderate in 4(4/18,22.22%)but large in 1 case(1/18,5.56%).Conclusion Image fusion technique was safe and feasible to guide portal vein puncture during TIPS.
作者
李自恒
赵卫
胡继红
易根发
潘文秋
万程
王滔
LI Ziheng;ZHAO Wei;HU Jihong;YI Genfa;PAN Wenqiu;WAN Cheng;WANG Tao(Imaging Center, the First Affiliated Hospital of Kunming Medical University,Kunming 650032, China)
出处
《中国介入影像与治疗学》
北大核心
2021年第9期526-530,共5页
Chinese Journal of Interventional Imaging and Therapy
关键词
肝硬化
门体分流术
经颈静脉肝内
高血压
门静脉
影像融合
liver cirrhosis
portasystemic shunt,transjugular intrahepatic
hypertension,portal
image fusion
