發(fā)布時(shí)間：2018-02-28 00:19

  本文關(guān)鍵詞： PSCV 門靜脈高壓 靜脈曲張 DSA 血管成像 肝內(nèi)分流　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:在肝硬化門靜脈高壓(portalhypertension,PHT)患者中,常存在著門體靜脈之間側(cè)支血管(portosystemic collateral vessels,PSCV)的開放,其血液流向通常為離肝血流。隨著門靜脈高壓的進(jìn)展,這些PSCV的數(shù)量及血流量的增加。PSCV是出血和肝性腦病發(fā)生的重要原因,明確PSCV的部位以及對其流入流出道的識別對臨床診斷及治療有重要意義。目前對PSCV的影像學(xué)研究主要是增強(qiáng)CT,且已有對PSCV進(jìn)行了多種分類的研究。但增強(qiáng)CT的研究不能準(zhǔn)確顯示PSCV的血流動(dòng)力學(xué)狀況,尚不是金標(biāo)準(zhǔn)。查閱文獻(xiàn),暫無直接PSCV的DSA造影表現(xiàn)的系統(tǒng)性研究。因此,本研究通過經(jīng)TIPS途徑置管到門脈屬支(腸系膜上靜脈和脾靜脈)行直接門靜脈DSA造影,觀察PSCV顯示的情況,并進(jìn)行分類和探討常見PSCV的臨床意義。目的:肝硬化門脈高壓患者經(jīng)TIPS途徑行門脈屬支置管門脈DSA造影,觀察PSCV的表現(xiàn),并探討常見PSCV開放的臨床意義。材料和方法:材料:回顧性收集2015年8月至2017年2月就診于我院并經(jīng)臨床確診的肝硬化門靜脈高壓患者,所有患者均為失代償期并行TIPS術(shù)治療,共入選274例,其中男性232例,女性42例。年齡51.29±12.63(16-79)歲。肝功能Child-Pugh分級A級32例,B級175例,C級67例。方法:1、經(jīng)TIPS途徑置管到門脈屬支,即腸系膜上靜脈和脾靜脈,分別行門靜脈DSA造影。2、觀察PSCV的顯示情況,并對PSCV進(jìn)行描述性的研究。3、觀察常見PSCV的特點(diǎn)并結(jié)合臨床指標(biāo)分析其臨床意義。搜集患者TIPS術(shù)前肝功能、腹水程度、術(shù)前門靜脈主干壓力等臨床指標(biāo),結(jié)合PSCV情況,經(jīng)統(tǒng)計(jì)分析判斷這些PSCV與術(shù)前門靜脈壓力(portal venous pressure,PVP)、肝功能Child分級及腹水程度的關(guān)系。計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,計(jì)數(shù)資料組間比較應(yīng)用X2檢驗(yàn),趨勢卡方檢驗(yàn)說明變量間線性關(guān)系。結(jié)果:274例患者均成功經(jīng)脾靜脈主干及腸系膜上靜脈主干完成門靜脈造影及常規(guī)TIPS手術(shù),技術(shù)成功率100%。6例患者右側(cè)頸內(nèi)靜脈狹窄或閉塞,經(jīng)左側(cè)頸內(nèi)靜脈穿刺置管。門靜脈造影后無操作相關(guān)的并發(fā)癥發(fā)生,如過敏、腹腔出血、穿刺點(diǎn)出血等。1、DSA下PHT失代償期患者PSCV的描述性研究根據(jù)PSCV在門脈系統(tǒng)的起始部位,可分為:(1)門靜脈分支型(2.55%);(2)門靜脈主干型(23.35%);(3)門靜脈屬支型(包括腸系膜上、下靜脈和脾靜脈)(12.77%);(4)混合型(61.31%),即PSCV起源上述2個(gè)或2個(gè)以上的部位。不同起源PSCV出現(xiàn)情況如下:1.1門靜脈分支起源75例(1)門靜脈左支:附臍靜脈開放42例(15.33%),門靜脈左支-膈下/胃靜脈分流4例(1.46%)。(2)門靜脈末梢:肝內(nèi)廣泛門肝靜脈末梢分流29例(10.58%)。1.2門靜脈主干起源216例胃左靜脈曲張216例(78.83%)。1.3門靜脈屬支起源188例(1)胃短/后靜脈曲張172例(62.77%)。(2)腸系膜上靜脈:腸系膜上靜脈-腹膜后靜脈曲張1例(0.36%),腸系膜上靜脈-胃底區(qū)靜脈曲張1例(0.36%),胃網(wǎng)膜靜脈曲張5例(1.82%)。(3)腸系膜下靜脈:直腸靜脈曲張2例(0.73%)。(4)脾(胃)腎分流23例(8.39%)。1.4混合型起源168例混合型起源的胃左靜脈合并其他血管141例(51.46%),胃短/后靜脈合并其他血管130例(47.45%)及附臍靜脈、門靜脈末梢、脾(胃)腎分流等上述靜脈的2個(gè)或2個(gè)以上起源。2、PHT失代償期患者常見PSCV的臨床意義(1)胃左靜脈、胃短/后靜脈及臍靜脈在不同肝功能分級、PVP等級及腹水程度中,出現(xiàn)率的差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)脾(胃)腎分流在不同肝功能分級、PVP及腹水程度出現(xiàn)率的差異沒有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)肝內(nèi)廣泛門肝靜脈末梢分流在不同PVP等級及腹水程度中出現(xiàn)率的差異沒有統(tǒng)計(jì)學(xué)意義(P0.05),但這種分流僅出現(xiàn)在肝功能B、C級患者中。結(jié)論:1、在TIPS術(shù)中完成門靜脈造影是安全和可行的。2、通過門脈DSA造影,根據(jù)PSCV的起源,可將其分為門靜脈分支型、門靜脈主干型、門靜脈屬支型及混合型。多數(shù)患者為混合型(61.31%),且可發(fā)生肝內(nèi)廣泛門肝靜脈末梢分流。3、胃左靜脈、胃短/后靜脈及附臍靜脈的出現(xiàn)率與PVP、肝功能分級及腹水程度均呈正相關(guān)。4、脾(胃)腎分流和肝內(nèi)廣泛門體靜脈末梢分流出現(xiàn)率與PVP、肝功能分級及腹水程度無相關(guān)性。5、肝內(nèi)廣泛門體靜脈末梢分流可能常出現(xiàn)在肝功能相對較差的(肝功能B、C級)肝硬化門靜脈高壓患者中。
[Abstract]:Background: in patients with liver cirrhosis and portal hypertension (portalhypertension, PHT) patients, often exists between portosystemic collateral vessels (portosystemic collateral, vessels, PSCV) is open, the blood flow is usually from the hepatic blood flow. With the development of portal hypertension, the number of PSCV and.PSCV increased blood flow is an important reason for bleeding and the occurrence of hepatic encephalopathy, clear PSCV and part of the inflow outflow recognition has important significance for clinical diagnosis and treatment. The present research on PSCV imaging is mainly to enhance the CT of PSCV, and has studied a variety of classification. But the enhancement of CT can not accurately display the hemodynamic status of PSCV. Is not the gold standard. The literature, a systematic study of DSA angiography showed no direct PSCV. Therefore, this research through the TIPS pathway catheter to the portal vein branches (superior mesenteric vein and splenic vein) Direct observation of portal vein angiography DSA, PSCV display, and classification and clinical significance of common PSCV. Objective: Patients with liver cirrhosis and portal hypertension by TIPS pathway for portal vein branches of portal vein catheterization DSA angiography, observe the performance of PSCV, and to explore the clinical significance of common PSCV. Materials and methods materials: retrospectively collected from August 2015 to February 2017 in our hospital for treatment of the patients with liver cirrhosis and portal hypertension clinical diagnosis, patients with decompensated parallel TIPS treatment, 274 patients were enrolled, of which 232 were male, 42 were female. Age 51.29 + 12.63 (16-79) years old. 32 cases of liver function Child-Pugh grade a, grade B 175 cases, C grade 67 cases. Methods: 1, after TIPS catheterization to the portal vein branches, namely the superior mesenteric vein and splenic vein, portal vein angiography were performed DSA.2 display of PSCV was observed, and the research on.3 descriptive observation of common PSCV, PSCV The characteristics and clinical data collected to analyze its clinical significance. The liver function in patients with TIPS ascites before operation, preoperative portal vein pressure and other clinical indicators, combined with PSCV, by statistical analysis to judge the PSCV and preoperative portal vein pressure (portal venous, pressure, PVP), the relationship between Child classification of liver function and ascites. The mean and standard deviation of measurement data (x + s) said the count data between groups were compared using X2 test, chi square test shows that the linear relationship between variables. Results: 274 patients were successful by splenic vein and superior mesenteric vein complete portal vein angiography and conventional TIPS surgery, the technical success rate of 100%.6 cases patients with right internal jugular vein stenosis or occlusion of the left internal jugular vein catheterization. Portal vein angiography after operation related complications occurred, such as allergies, abdominal hemorrhage, hemorrhage and.1, DSA PHT in decompensated patients 鑰匬SCV鐨勬弿榪版，

本文編號：1544944