经颈静脉肝内门体分流术后肝脏及相关脏器时间-密度曲线变化的临床意义及价值  

The Clinical Significance and Value of Time-Density Curve Changes of Liver and Related Organs after TIPSS

作　　者：吴晶晶 李迎春 普福顺 罗家滨 

机构地区：[1]云南省红河州第一人民医院放射科,661199

出　　处：《临床放射学杂志》2015年第4期563-566,共4页Journal of Clinical Radiology

基　　金：云南省基础应用研究基金项目(编号:2010CD171);云南省卫生厅内设研究基金项目(编号:2010WS0107)

摘　　要：目的探讨经颈静脉肝内门体分流术（TIPS）后肝脏及相关脏器时间-密度曲线（TDC）变化的临床意义及价值。方法对拟行TIPS的20例肝硬化患者于术前2-3天、术后1周分别行肝脏灌注扫描。记录并观察第一肝门下方（TIPS支架下端）门静脉主干层面门静脉、肝实质、脾实质等3个感兴趣区的TDC形态、达峰时间（TTP）和峰值（PV）的变化情况。结果与TIPS术前比较,术后门静脉、肝脏、脾脏TTP提前（t/Z=3.322、2.242、-2.298,P=0.004、0.037、0.022）和门静脉PV增高（t=-2.613,P=0.017）,差异有统计学意义;肝实质PV降低（t=1.137,P=0.270）,脾脏PV升高（t=1.137,P=0.144）,差异无统计学意义。脾脏TDC由术前的速升缓降型、缓升平台型、持续缓升型转变为术后速升缓降型。结论门静脉、肝实质、脾实质TDC变化可直观地反映TIPS术后肝脏血流动力学变化特点。Objective To explore the clinical significance and value of time-density curve （TDC） changes of the liver and related organs after transjugular intrahepatic portosystermic stent shunt （TIPSS）. Methods A total of 20 cirrhosis patients, who were scheduled for TIPSS operation, were included in this study. For all patients CT perfusion imaging （CTPI） was performed 2 - 3 days before as well as one week after the operation. The TDCs or regions of interest （ROIs） were drawn in the portal vein, the liver and the spleen. The time to peak （TFP） and the peak value （PV） of all ROIs were recorded. Results When compared with the preoperative ones, the postoperative TTP values of all ROIs came up earlier （ t/z = 3. 322, t/z = 2. 242 and t/z = - 2. 298 ; P = 0. 004, P = 0. 037 and P = 0. 022 respectively） and the portal PVs were increased （t = -2. 613, P = 0. 017）, and the differences were statistically significant; while the PV of liver parenchyma was reduced （t = 1. 137, P = 0.270） and the PV of spleen was increased （t = 1. 137, P = 0. 144）, and the differences were not statistically significant. Preoperative TDC of spleen showed ＂quickly up and slowly down＂, ＂slowly rising platform＂ or ＂continued slowly rising＂ patterns, which changed to ＂fast rising and slowly dropping＂ pattern after the opera- tion. Conclusion The changes of TDCs of the portal vein, liver parenchyma and spleen parenchyma can directly reflect the hepatic hemodynamic features of liver after TIPSS.

关 键 词：经颈静脉肝内门体分流术 灌注成像 体层摄影术 X线计算机 

分 类 号：R657.3[医药卫生—外科学]