下腔静脉隔膜型布-加综合征介入治疗前后血流动力学参数的模拟分析  

Analysis of simulated hemodynamic parameters of Budd-Chiari syndrome with perforated membrane of inferior vena cava before and after intervenfional therapy

作　　者：佴启元 平杰[1] 许伟[1] 徐浩[1] 祖茂衡[1] 魏梦雪[1] 张文耀[1] 

机构地区：[1]徐州医学院附属医院介入放射科,江苏221006

出　　处：《中华肝胆外科杂志》2016年第11期734-737,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的建立下腔静脉隔膜型布-力口综合征（BCS，隔膜有孔）三维模型，分析经皮腔内血管成形术（PTA）前后血流动力学参数变化，探讨与BCS术后复发相关的血流动力学因素。方法选取下腔静脉隔膜型BCS（隔膜有孔）患者，对其PTA前后MRI数据进行3D重建，应用CFD软件对血流动力学参数值进行模拟，结果以云图表示。结果术前下腔静脉狭窄有限元模型单元总数为16422个，结点总数为48170个；术后下腔静脉有限元模型单元总数为16539个，结点总数为51339个。建立的BCS3D模型有效反映了病变区域的血流动力学模式。对比PTA前后血流参数分布发现，在术前下腔静脉狭窄部位，壁面压力自远心端逐减，血流流速和壁面切应力最大；术后原狭窄部位血管中心流速仍较大，局部出现低压区，壁面剪切力仍高于正常血管，为血管再狭窄的形成提供了可能性。结论下腔静脉3D流体模型研究显示病变区域存在血流动力学变化，而血流模式的改变则会进一步影响血液局部流速、壁面压力及管壁切应力等血流动力学参数的分布。这些可能是影响布-加综合征术后复发的因素。Objective To establish a three-dimensional （3D） model of the diaphragm type of Budd-Chiari syndrome （BCS） with perforated membrane, to analyze changes of hemodynamic parameters pre and post percutaneous transluminal angioplasty （PTA） and to analyze any possibly related mechanical factors for postoperative recurrence in BCS. Methods The data on enhanced MRI from patients suffering from BCS with perforated diaphragm of inferior vena cava were reconstructed into a 3D model. Computational fluid dynamics （CFD） were applied for numerical simulation based on the model, and the results were expressed as cloud images. Results The total number of model units of the finite element model for preoperative inferior vena cava stenosis was 16 422, and the total number of nodes was 48 170. The total number of model units for postoperative inferior vena cava was 16 539, and the total number of nodes was 51 339. Hemodynamic patterns of the lesion areas were effectively reflected in the 3D flow dynamic model for BCS. By comparing the hemodynamic parameters before and after interventional therapy, the data indicated that there was a gradual decline in wall pressure from the telecentric side. The largest blood flow velocity as well as wall shear stress were observed in the stenotic area of inferior vena cava. Both a large postoperative vascular central velocity and a low increase in local pressure predicted occurrence of vascular restenosis. Conclusions The establishment of a 3D fluid model of inferior vena cava revealed that there were mechanical changes in the location of the lesion. Variations in blood flow patterns exert a far-reaching influence on distribution of hemodynamic parameters, including local blood flow velocity, vascular wall pressure and shear stress. All these might be related to recurrence of BCS after interventional therapy.

关 键 词：布-力口综合征 隔膜型 血流动力学 下腔静脉 有限元 三维成像 

分 类 号：R575[医药卫生—消化系统]