摘要
目的分析肝移植术后严重门静脉狭窄的三维成像特征与优势,评估门静脉支架植入术效果。方法回顾性分析10例肝移植术后因严重门静脉狭窄接受门静脉支架植入的患者的临床资料,分析严重门静脉狭窄的影像学特征、三维重建的成像优势及介入治疗效果。结果10例患者中狭窄类型包括向心性缩窄3例,曲折成角致狭窄2例,受压狭窄2例,长段狭窄和(或)血管闭塞3例。三维重建图像在狭窄的准确判断、狭窄类型的辨别和狭窄累及长度判断方面具有优势。所有患者均成功接受门静脉支架植入术,支架植入后门静脉最狭窄处直径较治疗前增加[(6.2±0.9)mm比(2.6±1.7)mm,P<0.05],吻合口流速较治疗前下降[(57±19)cm/s比(128±27)cm/s,P<0.05],近肝处门静脉主干流速较治疗前增加[(41±6)cm/s比(18±6)cm/s,P<0.05]。1例患者因介入穿刺引起肝内血肿,经保守观察治疗后好转,其余患者均未出现相关并发症。结论三维可视化技术可以立体直观展示狭窄部位、特征与严重程度,有利于临床医师进行治疗决策和辅助介入操作。及时的门静脉支架植入术可以有效逆转病变进程并改善门静脉血流。
Objective To analyze three-dimensional imaging characteristics and advantages for severe portal vein stenosis after liver transplantation,and to evaluate clinical efficacy of portal vein stent implantation.Methods Clinical data of 10 patients who received portal vein stent implantation for severe portal vein stenosis after liver transplantation were retrospectively analyzed.Imaging characteristics of severe portal vein stenosis,and advantages of three-dimensional reconstruction imaging and interventional treatment efficacy for severe portal vein stenosis were analyzed.Results Among 10 patients,3 cases were diagnosed with centripetal stenosis,tortuosity angulation-induced stenosis in 2 cases,compression-induced stenosis in 2 cases,long-segment stenosis and/or vascular occlusion in 3 cases.Three-dimensional reconstruction images possessed advantages in accurate identification of stenosis,identification of stenosis types and measurement of stenosis length.All patients were successfully implanted with portal vein stents.After stent implantation,the diameter of the minimum diameter of portal vein was increased[(6.2±0.9)mm vs.(2.6±1.7)mm,P<0.05],the flow velocity at anastomotic site was decreased[(57±19)cm/s vs.(128±27)cm/s,P<0.05],and the flow velocity at the portal vein adjacent to the liver was increased[(41±6)cm/s vs.(18±6)cm/s,P<0.05].One patient suffered from intrahepatic hematoma caused by interventional puncture,which was mitigated after conservative observation and treatment.The remaining patients did not experience relevant complications.Conclusions Three-dimensional visualization technique may visually display the location,characteristics and severity of stenosis,which is beneficial for clinicians to make treatment decisions and assist interventional procedures.Timely implantation of portal vein stent may effectively reverse pathological process and improve portal vein blood flow.
作者
赵洪强
刘影
马建明
李昂
于里涵
童翾
吴广东
卢倩
张跃伟
汤睿
Zhao Hongqiang;Liu Ying;Ma Jianming;Li Ang;Yu Lihan;Tong Xuan;Wu Guangdong;Lu Qian;Zhang Yuewei;Tang Rui(不详;Hepatopancreatobiliary Center,Beijing Tsinghua Changgung Hospital Affiliatal to Tsinghua University,Key Laboratory of Digital Intelligence Hepatology of Ministry of Education,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)
出处
《器官移植》
CSCD
北大核心
2024年第1期82-89,共8页
Organ Transplantation
基金
国家自然科学基金重点项目(81930119)
中国医学科学院医学与健康科技创新工程创新单元(2019-I2M-5-056)
北京清华长庚医院青年启动基金资助项目(12019C1012)。
关键词
肝移植
血管并发症
门静脉狭窄
介入治疗
三维可视化成像
门静脉支架
血流加速
门静脉高压
Liver transplantation
Vascular complication
Portal vein stenosis
Interventional therapy
Three-dimensional visualization imaging
Portal vein stent
Accelerated blood flow
Portal hypertension
