动态对比增强CT评价经颈静脉肝内门体分流术后显性肝性脑病的价值  

Application of dynamic enhanced CT in assessing overt hepatic encephalopathy after creation of transjugular intrahepatic portosystemic shunt

作　　者：王怡博 冯广森 张明勤 张文浩 WANG Yibo;FENG Guangsen;ZHANG Mingqin;ZHANG Wenhao(Department of Interventional Radiology,Henan Provincial Hospital of Traditional Chinese Medicine,Zhengzhou,Henan Province 450002,China)

机构地区：[1]河南省中医院介入放射科,河南郑州450002

出　　处：《介入放射学杂志》2025年第2期175-179,共5页Journal of Interventional Radiology

摘　　要：目的应用动态对比增强CT(DCE-CT)确定肝内门静脉血流分布,评价其对预防经颈静脉肝内门体分流术(TIPS)后显性肝性脑病(overt hepatic encephalopathy,OHE)的价值。方法回顾性分析2017年7月至2023年11月在河南省中医院接受TIPS治疗的110例肝硬化门静脉高压所致消化道出血患者临床资料。术前通过DCE-CT评估肝内门静脉血流分布类型。在不同分布类型肝内门静脉血流分布患者中比较门静脉左支、右支分流术后OHE发生率。结果脾静脉右支型患者中门静脉左支、右支分流术后OHE发生率分别为58.3%、21.1%,差异有统计学意义(P=0.022);脾静脉左支型、脾静脉弥散型患者中门静脉左支、右支分流术后OHE发生率比较差异均无统计学意义(P=0.246、0.846)。进一步亚组分析结果显示,脾静脉优势支分流、肠系膜上静脉优势支分流患者术后OHE发生率分别为20.8%、57.9%,差异有统计学意义(P=0.008)。结论TIPS术前利用DCE-CT评估肝硬化门静脉高压患者肝内门静脉血流分布,术中有选择地进行门静脉分支穿刺分流,可一定程度上降低术后OHE发生风险。Objective To determine the intrahepatic portal blood flow distribution by using dynamic contrast-enhanced CT(DCE-CT)scan,and to evaluate its application value in preventing overt hepatic encephalopathy(OHE)after transjugular intrahepatic portosystemic shunt(TIPS).Methods The clinical data of 110 patients with digestive tract hemorrhage due to cirrhotic portal hypertension,who received TIPS at Henan Provincial Hospital of Traditional Chinese Medicine of China from July 2017 to November 2023,were retrospectively analyzed.Preoperative DCE-CT was performed to evaluate the type of intrahepatic portal blood flow distribution.In patients with different types of intrahepatic portal blood flow distribution,the incidence of post-TIPS OHE was compared between the patients receiving portal vein left branch shunting and the patients receiving portal vein right branch shunting.Results In patients with the right splenic vein type,the incidences of post-TIPS OHE in left portal branch shunting and right portal branch shunting were 58.3%and 21.1%respectively,and the difference was statistically significant(P=0.022).In patients with the left splenic vein type and the diffuse distribution type,there was no statistically significant difference in the incidence of post-TIPS OHE between left portal branch shunting and right portal branch shunting(P=0.246 and 0.846 respectively).Further subgroup analysis results showed that the incidences of OHE in patients receiving splenic vein dominant branch shunting and in patients receiving superior mesenteric vein dominant branch shunting were 20.8%and 57.9%respectively,and the difference was statistically significant(P=0.008).Conclusion Pre-TIPS DCE-CT evaluation of intrahepatic portal blood flow distribution and intraoperative selective portal vein branch shunting can reduce the risk of postoperative OHE to a certain extent.

关 键 词：经颈静脉肝内门体分流术 显性肝性脑病 门静脉血流分布 

分 类 号：R575[医药卫生—消化系统]