摘要
目的评价三维可视化技术在布加综合征(BCS)下腔静脉阻塞伴危险侧支诊断及介入治疗中的应用价值。方法回顾分析2018年9月至2021年1月徐州医科大学附属医院28例下腔静脉阻塞伴危险侧支的BCS患者资料,其中男性11例,女性17例,平均年龄49.0岁。选取患者肝脏MRI增强扫描图像构建下腔静脉三维可视化模型。行正位及左侧位下腔静脉数字减影血管造影(DSA)。在三维可视化模型指导下开通下腔静脉。术后随访下腔静脉通畅情况。结果28例患者均成功构建下腔静脉三维可视化模型,共显示危险侧支51条,存在1、2、3、4条危险侧支患者分别为13、8、6、1例。规划穿刺路径与下腔静脉近心端长轴夹角平均22.2°。28例患者中,三维可视化模型可清晰显示危险侧支开口、走行及下腔静脉阻塞端位置形态28例(100.0%),优于DSA正位及左侧位清晰显示的6例(21.4%),差异有统计学意义(χ^(2)=20.045,P<0.05)。28例患者均成功开通下腔静脉,无并发症。28例患者随访2~30个月,平均18.4个月。25例患者下腔静脉血流通畅,3例患者分别于术后3、4、14个月出现下腔静脉再阻塞。结论三维可视化技术在BCS下腔静脉阻塞伴危险侧支的诊断和介入治疗中有较好的临床应用价值。
Objective To study the use of three-dimensional(3D)visualization in diagnosis and interventional treatment of patients with Budd-Chiari syndrome(BCS)presenting with inferior vena cava obstruction and dangerous collateral branches.Methods The data of 28 patients with BCS presenting with inferior vena cava obstruction and dangerous collateral branches treated at the Affiliated Hospital of Xuzhou Medical University from September 2018 to January 2021 were retrospectively analyzed.There were 11 males and 17 females with a mean age of 49.0 years.Enhanced MR images of these 28 patients were used to build 3D visualization of inferior vena cava.Anteroposterior and left lateral digital subtraction angiography(DSA)of inferior vena cava were performed.The inferior vena cava of these patients was recanalized under guidance of 3D visualization,and patency of inferior vena cava was determined on follow up.Results 3D visualization of inferior vena cava was successfully constructed in all the 28 patients,and 51 dangerous collateral branches were displayed.One,2,3 and 4 dangerous collateral branches were found in 13,8,6 and 1 patients,respectively.The average angle between the preoperative planning puncture route and the long axis of the proximal end of inferior vena cava was 22.2°.The orifices and courses of the dangerous collaterals and the shape of inferior vena cava could be clearly displayed on 3D visualization in all the 28 patients(100.0%),which were significantly better than the 6 patients(21.4%)using DSA obtained in the anteroposterior and left lateral positions(χ^(2)=20.045,P<0.05).The inferior vena cava was successfully recanalized in all the 28 patients without complications.On follow up of these patients for 2 to 30 months(mean 18.4 months),the inferior vena cava was patent in 25 patients.Three patients developed inferior vena cava re-obstruction at 3,4 and 14 months after interventional treatment,respectively.Conclusion 3D visualization was useful in the diagnosis and interventional treatment of patients with BCS presenting with inferior vena cava obstruction and dangerous collateral branches.
作者
刘行
张庆桥
肖晋昌
沙俊成
陈宏亮
康伟
丁寒
徐浩
祖茂衡
Liu Xing;Zhang Qingqiao;Xiao Jinchang;Sha Juncheng;Chen Hongliang;Kang Wei;Ding Han;Xu Hao;Zu Maoheng(Department of Interventional Radiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2021年第11期838-841,共4页
Chinese Journal of Hepatobiliary Surgery
