超声对TIPS术后分流道功能评估的方法学研究

对60例肝硬化患者行经颈静脉肝内门体分流术(TIPS),分别在术前及术后1周、1、3、6、12个月行多普勒超声检查,比较术后1周与术前疗效,并采用凸阵探头CDFI、B-flow及相控阵探头CDFI 3种模式监测分流道功能,数据显示术后1周门静脉内径、脾脏大小显著下降,门静脉流速显著增快,胃左静脉血流方向以向肝血流为主.凸阵探头CDFI、B-flow模式以及相控阵探头CDFI模式对TIPS分流道全程血流显示率分别为82.4%、74.0%及97.9%.数据分析表明相控阵探头CDFI模式对判断分流道闭塞具有较高准确性;"至少2种模式显示局部充盈缺损和(或)局部血流加速"的方法有利于判断分流道内血栓存在或狭窄;同时,结合患者腹水变化、胃左静脉血流方向、临床一般症状等,更加有利于判断TIPS分流道功能状态.

Methodology study of ultrasonography in detecting transjugular intrahepatic portosystemic shunt dysfunction

Sixty patients with cirrhosis underwent transjugular intrahepatic portosystemic shunt(TIPS).Clinical efficacy was observed using doppler ultrasound before and 1 week, 1, 3, 6, 12 months after operation.Convex array probe in CDFI, in B-flow and phased array probe in CDFI were adopted to monitor the stent function.The statistics showed that the diameter of portal vein and spleen size decreased and the peak flow in portal vein increased 1 week after operation compared with that before operation.Direction of blood flow in the left gastric vein was mainly to the liver after operation.Convex array probe in CDFI, in B-flow and phased array probe in CDFI of the rate of stents patency were 82.4%, 74.0% and 97.9% respectively.The analysis of the statistics demonstrated that phased array probe in CDFI was more accurate than other modes in the determination of the stent occlusion;at least two modes in showing filling defected blood flow or accelerated blood flow within stent were better than single mode.Meanwhile,the combination of the change of ascites, the direction of blood flow in the left gastric vein and general clinical symptoms are more valuable in evaluating the shunt dysfunction.