与TIPSS相关的影像学解剖关系的研究

目的应用多种医学影像学及解剖学方法，研究与经颈静脉肝内门腔静脉内支架分流术（ＴＩＰＳＳ）密切相关的解剖学改变，以提高操作的成功率、可靠性及安全性，并探索新的导向方式及分流途径。材料与方法采用ＭＲＩ、ＣＴ、血管造影、肝脏血管铸型等手段，研究肝动脉、胆管和门静脉的伴行情况及相互空间关系，估计各种穿刺途径对其损伤的可能性。分析肝段下腔静脉与门静脉的空间关系。结果胆管和肝动脉主要位于门静脉分叉及主干的前方、前上方；在右干分叉部及左干角部、矢状部分布不规则，可位于其后上或左右方。肝动脉，特别是肝右动脉和门静脉关系密切，可作为穿刺导向。肝段下腔静脉距门静脉分叉及左右干均较近，穿刺有较大的安全范围，可作为新的分流途径。结论熟悉肝脏血管解剖、应用有效导向、避免胆道和肝动脉损伤可提高ＴＩＰＳＳ疗效

The anatomic study of imageology related to TIPS

Purpose To further increase the success rate, safety and reliability of TIPS procedures and search for new ways for portosystemic shunts and puncture guidance. Materials and methods Using various medical imaging and anatomical methods, the detail relationships of hepatic arteries(HA) and bile ducts(BD) to portal veins(PV) were studied and the possibilities of injury to them in different puncture routes were estimated. The anatomic relationships between the hepatic segment of inferior vena cava (HIVC) and PV and the possibility of portal vena cava shunt were also investigated. Results The BD and HA were mainly located anterior or anterior superior to the PV branch or mainstams of right PV and left PV, but the corner and sagittal parts of left PV and bifurcation of right PV were often surrounded by them. HA, especially the right HA, going parallel to the mainstam of right PV in a regular ways, could be used for PV puncture guidance. HIVC came close to the PV in the region of hepatic porta, puncture from inferior vena cava (IVC) to PV possessing a wide range of safety, could be used as a new route for portal cava shunt in order to avoid the hepatic vein. Conclusion Familiarization with liver anatomy and reliable guidance during TIPS procedure was crucial to avoid serious complications of damage to BD and HA. Creating shunt with stent grafts from the HIVC to PV directly is a promising way to prevent restenosis.