彩色多普勒超声对经颈静脉肝内门体分流术后支架功能障碍的诊断价值  

Diagnostic value of color Doppler ultrasonography in detecting transjugular intrahepatic portosystemic shunt dysfunction

作　　者：韩浩[1] 杨建[1] 诸葛宇征[2] 金志斌[1] 吴敏[1] 

机构地区：[1]南京大学医学院附属鼓楼医院超声诊断科,南京市210008 [2]南京大学医学院附属鼓楼医院消化内科,南京市210008

出　　处：《临床超声医学杂志》2015年第8期522-525,共4页Journal of Clinical Ultrasound in Medicine

基　　金：南京市卫生局重点项目(ZKX09020)

摘　　要：目的探讨彩色多普勒超声诊断经颈静脉肝内门体静脉分流术(TIPS)后支架功能障碍的临床价值。方法 33例门静脉高压患者,接受TIPS治疗,术后临床怀疑支架功能障碍35例次。超声检测其门静脉主干内径、血流速度以及支架内血流速度,计算充血指数,并与DSA诊断结果对比。结果与DSA比较,超声诊断支架功能障碍符合率为100%,诊断支架狭窄和闭塞符合率为89.5%、93.8%。门静脉左支矢状部内血流方向,支架通畅时,60.0%出现离肝血流,而支架功能障碍时出现离肝血流为5.7%。支架功能障碍时,门静脉流速(26.02±8.49)cm/s,内径(1.49±0.10)cm,血流量(1563.38±529.82)ml/min,充血指数0.14±0.08;与支架通畅时比较,其上述指标均上升(P<0.05)。结论彩色多普勒超声诊断TIPS支架功能障碍具有较高的准确性,可作为TIPS术后随访的首选方法。Objective To evaluate the role of color Doppler ultrasonography （CDUS） in the detection of shunt dysfunction in patients after transjugular intrahepatic portosystemic shunt （TIPS） operation. Methods CDUS was performed in 33 patients who underwent TIPS and were and/or clinically suspected of having 35 shunt dysfunction. They all underwent CDUS and DSA. Ultrasonography was used to evaluate the presence of a spectral waveform or color flow signal within the shunt, the peak velocity in the shunt and in the main portal vein（PV）, the diameter of PV, and the flow direction of sagittal part of portal vein after the procedure. The findings were analyzed and DSA results were used as the golden criteria. Results The diagnostic accordance rate of dysfunction by CDUS was 100% as compared to that by DSA, and the diagnostic accordance rates of stent stenosis and occlusion were 89.5% and 93.8%. The hepatofugal flow of the sagittal part of portal vein was detected in 21 of 35 cases（60.0%） without dysfunction shunts and in 2 of 35 cases （5.7%） with dysfunction shunts. When there was dysfunction in stents, the peak velocity [（26.02±8.49）cm/s] and flow[（1563.38±529.82）ml/min] within the PV were significantly lower, but the diameter [（1.49±0.10）era] and congestion index（0.14±0.08） of PV were significantly higher（P〈0.05）. Conclusion CDUS has high accuracy in the diagnosis of shunt dysfunction in patients after TIPS operation. It can be the preferred method for routine follow-up examination after TIPS procedures.

关 键 词：超声检查 门静脉高压 经颈静脉肝内门体分流术 数字减影血管造影 

分 类 号：R445.1[医药卫生—影像医学与核医学]