门脉充血指数的动态观察判定TIPSS支架管功能的价值

目的　探讨通过测定经颈静脉肝内门体分流 (TIPSS)手术前后门脉充血指数 (CI)的变化以判定支架管功能的价值。方法　测定并分析比较支架管功能正常组和支架管功能障碍 (狭窄或闭塞 )组TIPSS手术前后CI的演变情况。结果　术前支架管功能正常组和支架管功能障碍组CI无明显差异 (P >0 .0 5 ) ,术后 1周两组CI均较术前明显下降 (P <0 .0 1) ,但组间比较差异不显著 (P >0 .0 5 )。功能正常组术后各时相点 (1周、1月、3月、6月、12月、18月、2 4月 )之间CI均无明显差异 (P >0 .0 5 ) ,但均与术前差异显著 (P <0 .0 1)。而功能障碍组在出现狭窄或闭塞前各时相点 (1周、1月、3月 )之间所测CI也无差异 (P >0 .0 5 ) ,当出现狭窄、闭塞时 ,CI均较前各时相点显著升高 (P<0 .0 1)。结论　TIPSS手术前后CI的波动间接反映了支架管功能演变情况 ,动态观察CI变化可作为超声直接显像支架管评估其功能的方法的重要补充。若当超声直接显像支架管困难时 ,对CI的测定价值更大

Value of Follow-up of CI in Evaluating Shunt Function after TIPSS

Objective To evaluate the reliability of follow-up of Congestion index (CI) in diagnosis of shunt function after transjugular intrahepatic portosystemic stent shunt (TIPSS).Methods CI were detected and compared in patients with normal shunt function and with shunt failure after TIPSS.Results There were no difference of CI before or after TIPSS between patients with normal shunt function and patients with shunt failure,but the two groups all showed a sharp decrease in CI one week after TIPSS (P<0.01,respectively).After TIPSS,CI in patients with normal shunt function in one week,one month,three months,six months,twelve months eighteen months,twenty-four months showed no difference with each other,but much lower than that before TIPSS.(P<0.01,respectively).In dysfunction shunt group,there were also no differences of CI in one week,one month,three months after TIPSS,but once TIPSS malfunction happened,CI increased significantly (P<0.01) compared with those in one week,one month,three months after TIPSS.Conclusions The changes of CI before and after TIPSS reflect the function of shunt.The follow-up of CI in portal vein is an important method for assessment of shunt function,especially when ultrasound examination fails to well image the TIPSS stent.