声触诊组织量化技术无创评价经颈静脉肝内门-腔分流术疗效的可行性研究  

Study of virtual touch tissue quantification in noninvasive assessment of the effect of transjugular intrahepatic portosystemic stent shunt

作　　者：张明琼[1] 冉海涛[1] 叶小萍[3] 朱叶锋[1] 张大志[2] 

机构地区：[1]重庆医科大学超声影像学研究所重庆医科大学附属第二医院超声科,400010 [2]重庆医科大学超声影像学研究所重庆医科大学附属第二医院感染科,400010 [3]重庆医科大学附属第一医院超声科

出　　处：《中华超声影像学杂志》2013年第5期402-405,共4页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金资助项目（81071157）;重庆市科技攻关重点项目（2009AB5216）

摘　　要：目的探讨声触诊组织量化（virtual touch tissue quantification，VTQ）技术无创评价经颈静脉肝内门-腔分流术（transjugular intrahepatic portosystemic stent shunt，TIPSS）疗效的可行性。方法应用VTQ技术对24例肝硬化门静脉高压预行TIPSS分流术患者分别测量手术前后肝、脾剪切波速度（shear wave velocity，SWV）；并于手术时测量门静脉压力（portosystemic pressure gradient，PPG）；比较手术前后肝、脾SWV值的变化及与PPG的相关性。同时对14例患者进行术后1个月的随访。结果PPG和睥SWV值在手术前为（27，87±4，68）mmHg和（3．49±0．40）m／s，术后为（16．46±3．76）mmHg和（3．08±0．39）m／s，两者的差异均有统计学意义（P均〈0．05）；肝swV值在手术前后的差异无统计学意义（P=0．130）。脾swV值与PPG呈高度正相关（r=0．602，P=0．000）；肝swV值与PPG无相关性（r=0．154，P=0．296）。14例随访患者术前、术后1周、术后1个月的脾swV值两两比较差异均有统计学意义（P均〈0．05）；而肝swV值两两比较差异均无统计学意义（P均〉0．05）。结论VTQ技术测量的脾swV值可用于定量监测TIPSS分流术前后门静脉压力的变化，无创评价手术疗效，但目前还未发现肝SwV值可以用于评价其手术疗效。Objective To explore the feasibility of virtual touch tissue quantification（VTQ） technique in noninvasive assessment of transjugular intrahepatic portosystemie stent shunt （TIPSS）. Methods Twenty-four patients were enrolled in this study. Shear wave velocity（SWV） of the liver and spleen were obtained by VTO technique on one day before TIPSS insertion and one week after TIPSS placement, and the portal vein pressure was measured while placing the TIPSS. The correlation between SWV of the liver and spleen and portal venous pressure were analysed. In addition, fourteen patients were followed up for one month after TIPSS placement. Results There was significant difference in portal vein pressurepre [（27.82 ± 4.07） mm Hg] and post [（16.26 ± 3.10） mm Hg] TIPSS insertion. The SWV of the liver in patients pre and post TIPSS measured （2.43 ± 0.37）m/s and （2.40 ± 0.34）m/s,respectively. The SWV of the spleen in patients pre and post TIPSS were （3.49± 0.40）m/s and （3.08 ± 0.39）m/s, respectively, there was significant difference （ P = 0. 000）. However, SWV of the liver pre and post TIPSS placement was no significant difference（ P = 0. 130）. And as well as the patients which were followed up for one month after TIPSS placement. A significant,direct,linear correlation（ r = 0. 602, P = 0. 000） was found between SWV of the spleen and portal vein pressure, but liver SWV was not correlated with the portal venous pressure. Conclusions SWV of the spleen measured by VTQ technique has a significant correlation with portal vein pressure. Hence, the spleen SWV based on VTQ technique can be used as a non-invasive method for quantitatively in monitoring the portal vein pressure as the function of the TIPSS. However, evidence to support a similar role for liver stiffness is lacking

关 键 词：超声检查 门-体分流术 经颈静脉肝内 高血压 门静脉 声触诊组织量化 

分 类 号：R575[医药卫生—消化系统] R44[医药卫生—内科学]