CAJ | 학술논문

目的：探讨多层螺旋CT扫描成像（multislice computed tomography，MSCT）及多层螺旋CT门静脉血管成像（ multislice computed tomography portography ， MSCTP ）在颈静脉肝内门体分流术（transjugular intrahepatic portosystemic stent shunt，TIPS）联合胃冠状静脉栓塞术（gastric coronary vein embolization，GCVE）术前的应用价值。方法126例肝硬化门静脉高压合并上消化道出血或大量腹水拟行TIPS联合GCVE患者，术前行MSCT及MSCTP检查。采用最大密度投影（maximum intensity projection， MIP）、多平面重建（multi-planar reformation，MPR）、容积再现（volume rendering，VR）和表面遮盖显示（shaded surface display，SSD）等后处理技术全面了解肝脏情况。结果 MSCT及MSCTP能清晰显示肝硬化肝脏形态变化、肝静脉与门静脉空间位置关系、门静脉侧支循环开放程度和范围以及腹水等情况，为TIPS联合GCVE术前评估提供了重要的解剖信息。结论 MSCT及MSCTP是肝硬化门脉高压症无创性的可靠检查方法，可进一步明确诊断，对TIPS联合GCVE术中准确引导门静脉穿刺及曲张静脉栓塞具有重要的指导意义。
목적：탐토다층라선CT소묘성상（multislice computed tomography，MSCT）급다층라선CT문정맥혈관성상（ multislice computed tomography portography ， MSCTP ）재경정맥간내문체분류술（transjugular intrahepatic portosystemic stent shunt，TIPS）연합위관상정맥전새술（gastric coronary vein embolization，GCVE）술전적응용개치。방법126례간경화문정맥고압합병상소화도출혈혹대량복수의행TIPS연합GCVE환자，술전행MSCT급MSCTP검사。채용최대밀도투영（maximum intensity projection， MIP）、다평면중건（multi-planar reformation，MPR）、용적재현（volume rendering，VR）화표면차개현시（shaded surface display，SSD）등후처리기술전면료해간장정황。결과 MSCT급MSCTP능청석현시간경화간장형태변화、간정맥여문정맥공간위치관계、문정맥측지순배개방정도화범위이급복수등정황，위TIPS연합GCVE술전평고제공료중요적해부신식。결론 MSCT급MSCTP시간경화문맥고압증무창성적가고검사방법，가진일보명학진단，대TIPS연합GCVE술중준학인도문정맥천자급곡장정맥전새구유중요적지도의의。
Objective To evaluate the clinical application of preoperative multi-slice computed tomography (MSCT) and multi-slice computed tomography portography (MSCTP) in performing transjugular intrahepatic portosystemic stent shunt (TIPSS) combined with gastric coronary vein embolization (GCVE). Methods A total of 126 patients with cirrhosis complicated by upper gastrointestinal bleeding or massive ascites due to portal hypertension were enrolled in this study. The patients were arranged to receive TIPSS together with GCVE. Before the treatment, MSCT and MSCTP were performed in all patients. By using post-processing techniques, including maximum intensity projection (MIP), multiplanar reformation (MPR), volume rendering (VR) and surface shade display (SSD), the anatomy of liver was comprehensively evaluated. Results Both MSCT and MSCTP could clearly display morphologic changes of liver , the spatial relationship of the portal and hepatic veins , the degree and extent of portal collateral circulation , and the severity of ascites, which provided important anatomical information for preoperative evaluation of TIPSS and GCVE. Conclusion MSCT and MSCTP are non-invasive and reliable examinations for the diagnosis of cirrhosis with portal hypertension, it can further clarify the diagnosis and guide the performance of TIPSS and GCVE.