CT影像融合引导经颈静脉肝内门体分流术中门静脉穿刺  

CT Image fusion-guided portal vein puncture during transjugular intrahepatic portosystemic shunt

作　　者：张永裕[1] 贺嘉男 王大帅 赵逆 黄伟乐 郭辉[1] Yongyu Zhang;Jianan He;Dashuai Wang;Ni Zhao;Weile Huang;Hui Guo(Department of Interventional Vascular Surgery,Interventional Medical Centre,the Fifth Affiliated Hospital of Sun Yat-sen University,Guangdong Zhuhai 519000,China)

机构地区：[1]中山大学附属第五医院介入医学中心介入血管外科,广东珠海519000

出　　处：《中华介入放射学电子杂志》2022年第4期365-370,共6页Chinese Journal of Interventional Radiology：electronic edition

基　　金：珠海市社会发展领域科技计划医疗卫生项目(102240102045)

摘　　要：目的评估利用2D-3D配准CT影像融合导航技术引导经颈静脉肝内门体分流(transjugular intrahepatic portosystemic shunt,TIPS)术中门静脉穿刺的可行性、安全性与应用价值。方法回顾性收集2016年3月至2022年9月在我院接受TIPS的肝硬化门静脉高压症的48例患者临床资料,男39例、女9例,年龄35~88(55.04±11.65)岁。根据引导方式分常规组及融合组:常规组31例,于DSA透视引导门静脉穿刺;影像融合组17例,以CT影像融合技术引导门静脉穿刺。定量分析影像融合术前CT门静脉造影重建的3D图像与数字减影血管造影门静脉图像的误差,对比两组间门静脉穿刺次数、穿刺时间、对比剂用量、X线曝光时间及剂量面积乘积、累积空气比释动能、手术时间,以及穿刺相关并发症。结果两组患者均成功施行TIPS,常规组穿刺相关并发症5例,术后因肝功能衰竭死亡1例,融合组未发生穿刺相关并发症。图像融合纵向误差1~10 mm(2.82±2.43 mm),横向误差1~5 mm(2.06±1.20 mm)。与常规组相比,融合组减少了门静脉穿刺次数、穿刺时间、对比剂用量、X曝光时间及剂量面积乘积、累积空气比释动能,其差异有统计学意义(P<0.05);融合组穿刺相关并发症、手术时间低于常规组,但其差异无统计学意义。结论利用2D-3D配准CT影像融合导航技术引导TIPS术中门静脉穿刺安全、可行,有助于提高穿刺准确性,减少穿刺时间及辐射剂量、对比剂用量,值得临床推广。Objective To evaluate the feasibility,safety and utility of 2D-3D registration method of CT image fusion(IF)technology for portal vein puncture during transjugular intrahepatic portosystemic shunt(TIPS)placement.MethodsThe clinical data of 48 patients with cirrhosis and portal hypertension who had undergone TIPS in our hospital from March 2016 to September 2022 were retrospectively collected.There were 39 males and 9 females with a mean age of 55 years(range:35~88),and they were divided into conventional group(n=31)and fusion group(n=17).In the conventional group,portal vein puncture during TIPS placement was performed with DSA fluoroscopy guidance,and CT image fusion was used to guide the portal vein puncture in the fusion group.Mismatch between three-dimensional pre-procedure computed tomography angiography and digital subtraction angiography(DSA)images of portal vein on image fusion was quantitatively analyzed.Number of the portal vein puncture attempts,puncture time,contrast agent dosage,X-ray exposure time and dose-area product,cumulative air kerma,procedure time and puncture-related complications were compared between the two groups.ResultsTIPS was successfully performed in both groups.There were 5 cases of puncture-related complications in the conventional group and one patient died of liver failure after operation.No puncture-related complications occurred in the fusion group.The mismatch value was 1~10 mm(2.82±2.43 mm)in cranio-caudal axis and 1~5 mm(2.06±1.20 mm)laterally.Number of the portal vein puncture attempts,puncture time,contrast agent dosage,X-ray exposure time and dose-area product and cumulative air kerma of fusion group were shorter or less than those of conventional group(P<0.05).The puncture-related complications and procedure time of fusion group were less than those of conventional group without statistically significant difference.ConclusionsThe 2D-3D registration method of CT image fusion technology for portal vein puncture during TIPS placement is feasible and safe,which might impro

关 键 词：影像融合 经颈静脉肝内门体分流术 门静脉高压 门静脉穿刺 影像引导 

分 类 号：R47[医药卫生—护理学]