CAJ | 학술논문

目的：彩色多普勒超声评价限制性经颈静脉肝内门体分流术（TIPS）联合食管胃底曲张静脉组织胶栓塞手术（SEVE）前后门静脉及分流道血流动力学特征。方法51例行TIPS联合SEVE患者，于术前及术后1周，1、6、12个月，超声测量门静脉内径和最大血流速度，观察门静脉主干及左右分支内血流方向和门静脉有无血栓，术后超声测量分流道支架内径和最大血流速度，观察有无血流及血流方向。结果51例患者术后随访期间无一例死亡，生存率为100％；发生肝性脑病4例，发生率为8％；再出血8例，发生率为16％；支架狭窄及闭塞各2例，总发生率为8％。门静脉内径术前至术后12个月变化差异无统计学意义。门静脉血流速度术后1周，1、6、12个月较术前增大（P＜0．001）；术后6、12个月均较术后1周，1个月减小（P＜0．05）。37例门静脉分支内可见反流，占73％。术后6、12个月支架内血流速度较术后1周，1个月下降（P＜0．05）。结论彩色多普勒超声已成为术前检查及术后随访的首选方法，术后门静脉和支架血流速度呈缓慢下降。
목적：채색다보륵초성평개한제성경경정맥간내문체분류술（TIPS）연합식관위저곡장정맥조직효전새수술（SEVE）전후문정맥급분류도혈류동역학특정。방법51례행TIPS연합SEVE환자，우술전급술후1주，1、6、12개월，초성측량문정맥내경화최대혈류속도，관찰문정맥주간급좌우분지내혈류방향화문정맥유무혈전，술후초성측량분류도지가내경화최대혈류속도，관찰유무혈류급혈류방향。결과51례환자술후수방기간무일례사망，생존솔위100％；발생간성뇌병4례，발생솔위8％；재출혈8례，발생솔위16％；지가협착급폐새각2례，총발생솔위8％。문정맥내경술전지술후12개월변화차이무통계학의의。문정맥혈류속도술후1주，1、6、12개월교술전증대（P＜0．001）；술후6、12개월균교술후1주，1개월감소（P＜0．05）。37례문정맥분지내가견반류，점73％。술후6、12개월지가내혈류속도교술후1주，1개월하강（P＜0．05）。결론채색다보륵초성이성위술전검사급술후수방적수선방법，술후문정맥화지가혈류속도정완만하강。
Objective To describe the hemodyna mic characteristics of the portal vein and stents before and after creation of restrictive transjugular intrahepatic portosystemic shunt (TIPS)combined with selective esophageal and gastric variceal embolization (SEVE) using color Doppler ultrasound. Methods Fifty-one patients were enrolled. Inner diameter of portal vein and peak flow velocity were measured,and thrombus and direction of flow in the main,right and left portal veins were observed using ultrasound before and 1 week,1,6,12 months after operation. Inner diameter of stent and peak flow velocity were measured, and bloodstream and direction of flow was observed using ultrasound after operation. Results The survival rate of 51 patients was 100% during follow- up time. The occurring rate of hepatic encephalopathy was 8%(4/51). The rate of rehemorrhagia was 16%(8/51). The primary shunt dysfunction was 8%(4/51,2 for stent stenosis,2 for stent occlusion). There was no statistical significance for the diameter of portal vein before and 12 months after operation . Peak flow velocity in portal vein increased 1 week,1,6,12 months after operation compared with that before operation (P<0.001). The peak flow velocity in portal vein decreased 6 ,12 months after operation compared with that 1 week,1 month after operation(P<0.05). In 37 patients(73%),flow direction in the left or right portal vein was hepatofugal after operation. The peak flow velocity in stent decreased 6,12 months after operation compared with that 1 week,1 month after operation(P<0.05). Conclusion Peak flow velocity in portal vein and stent after operaion was decreased slowly. Color Doppler ultrasound was proved to be a useful noninvasive diagnostic method to assess patients who underwent TIPS combined with SEVE.