声触诊组织量化技术评估经颈静脉肝内门体分流术联合胃冠状静脉栓塞术疗效

目的 探讨应用声触诊组织量化(VTQ)技术测量脾脏剪切波速度(SSWV)无创评价经颈静脉肝内门体分流术(TIPS)联合胃冠状静脉栓塞术(GCVE)疗效的价值。方法 将19例接受TIPS联合GCVE治疗的肝硬化门静脉高压患者分为A(13例,接受1次治疗)、B(6例,首次治疗后因支架闭塞再次接受治疗)两组。应用VTQ技术分别与治疗前1天、治疗后6天测量SSWV,以脉冲波多普勒测量门静脉主干血流速度(PVV)、脾静脉主干血流速度(SVV)。于TIPS联合GCVE治疗过程中,以直接测压法测量支架植入前及植入后的门静脉压(PPG),并进行统计分析。结果 TIPS联合GCVE治疗后,A、B两组PPG均较治疗前明显减低(P均<0.05);SSWV均较治疗前明显减低,PVV、SVV均较治疗前明显升高(P均<0.05)。A、B两组治疗前及治疗后SSWV均与PPG呈正相关(P均<0.05),PVV、SVV均与PPG无相关性(P均>0.05)。结论 应用VTQ技术所测SSWV与PPG存在相关性,可作为TIPS联合GCVE治疗前后监测门静脉压力的无创定量评估指标。

Virtual touch tissue quantification in assessment of therapeutic effect for transjugular intrahepatic portosystemic shunt combined with gastric coronary vein embolization

Objective To evaluate the application value of the spleen shear wave velocity (SSWV) obtained by virtual touch tissue quantification (VTQ) technique in noninvasive assessment of transjugular intrahepatic portosystemic shunt (TIPS) and gastric coronary vein embolization (GCVE) efficacy. Methods Totally 19 patients with portal hypertension underwent TIPS and GCVE were enrolled and divided into two groups. There were 13 cases underwent once treatment in group A and 6 restenosis cases underwent twice treatment of TIPS and GCVE in group B. SSWV were obtained by VTQ technique one day before and 6 days after TIPS and GCVE. Meanwhile, the portal vein velocity (PVV) and splenic vein velocity (SVV) were measured with pulse wave Doppler. The portosystemic pressure gradient (PPG) was directly measured before and after stent implantation during TIPS and GCVE, respectively. And statistical analysis was preformed. Results PPG and SSWV values of group A and B decreased after TIPS and GCVE (all P<0.05). The PVV and SVV increased after the treatment in both of A and B groups (all P<0.05). SSWV values of group A and B correlated positively with PPG (all P<0.05). And there was no significant correlation among PPG, PVV and SVV (all P>0.05). Conclusion The SSWV measured by VTQ technique which correlates positively with portal vein pressure can be used as a quantitative index in monitoring portal vein pressure before and after the treatment of TIPS and GCVE.