超声凸阵探头及相控阵探头在预测TIPS覆膜支架功能障碍中的应用价值
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摘要
分析覆膜支架经颈静脉肝内门-体分流术(TIPS)患者手术预后、对比分析凸阵探头及相控阵探头在判断覆膜支架功能障碍中的应用价值。对医院介入科成功进行覆膜支架TIPS手术的226位患者进行回顾性分析,根据临床症状筛查出可疑分流道功能障碍患者,进行数字减影血管造影(DSA)检查,以其DSA血管造影为对照标准,依据超声判断标准,分别分析凸阵探头及相控阵探头在判断分流道功能障碍的灵敏度。受试者工作特征曲线(ROC)被用来评估两种探头诊断的准确性。226例手术患者,平均随访(31±16)个月,发生分流道功能障碍患者35例(总发生率15. 5%),共有27例患者死亡(总生存率88. 1%)。通过统计分析,相控阵探头的ROC曲线下区域的面积远远大于凸阵探头ROC曲线下区域的面积(0. 95 vs 0. 88,P=0. 01)。相控阵探头CDFI模式比凸阵探头CDFI模式能更准确的显示分流道内全程血流信号,对分流道功能障碍预测价值显著高于凸阵探头。
To analyze the surgical prognosis of patients undergoing covered stents TIPS,and comparatively analyze the application value of convex array probes and phased array probes in judging the dysfunction of covered stents.Retrospective analysis was performed on patients undergoing TIPS surgery in our hospital. DSA angiography was performed on patients with suspicious shunt dysfunction according to clinical symptoms. Using DSA angiography as the control standard,according to the ultrasonic criteria,the accuracy of the convex probe and the phased array probe to diagnose the function of the shunt was analyzed. In 226 surgical patients,the mean follow-up was(31 ±16) months. There were 35 patients with shunt dysfunction( incidence rate was 15. 5%) and a total of 27 patients died( survival rate was 88. 1%). Through statistical analysis,areas under the ROC curve of the phased array probe is significantly higher than those of the convex array probe(0. 95 vs 0. 88,P = 0. 01). The phased array probe CDFI mode could display the whole blood flow signal in the shunt more accurately than the convex array probe CDFI mode. The predictive value of phased array probe for detection of shunt dysfunction is significantly higher than that of the convex array probe.
To analyze the surgical prognosis of patients undergoing covered stents TIPS,and comparatively analyze the application value of convex array probes and phased array probes in judging the dysfunction of covered stents.Retrospective analysis was performed on patients undergoing TIPS surgery in our hospital. DSA angiography was performed on patients with suspicious shunt dysfunction according to clinical symptoms. Using DSA angiography as the control standard,according to the ultrasonic criteria,the accuracy of the convex probe and the phased array probe to diagnose the function of the shunt was analyzed. In 226 surgical patients,the mean follow-up was(31 ±16) months. There were 35 patients with shunt dysfunction( incidence rate was 15. 5%) and a total of 27 patients died( survival rate was 88. 1%). Through statistical analysis,areas under the ROC curve of the phased array probe is significantly higher than those of the convex array probe(0. 95 vs 0. 88,P = 0. 01). The phased array probe CDFI mode could display the whole blood flow signal in the shunt more accurately than the convex array probe CDFI mode. The predictive value of phased array probe for detection of shunt dysfunction is significantly higher than that of the convex array probe.
引文
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[8] Wen J M,Gaba R C. Transjugular intrahepatic portosystemic shunt dysfunction:concordance of clinical findings,Doppler ultrasound examination,and shunt venography[J]. J Clin Imaging Sci,2016,6(3):1-7.
[9]张铠,赵卫. TIPS联合胃冠状静脉栓塞治疗肝硬化门静脉高压伴上消化道出血[J].介入放射学杂志,2017,7(1):601-6.
[10] Dariushnia S R,Haskal Z J,Midia M,et al. Quality improvement guidelines for transjugular intrahepatic portosystemic shunts[J]. J Vasc Interv Radiol,2016,27(1):1-7.
[11] Carr C E,Tuite C M,Soulen M C,et al. Role of ultrasound surveillance of transjugular intrahepatic portosystemic shunts in the covered stent era[J]. J Vasc Interv Radiol,2006,17(8):1297-305.
[12] Dodd 3rd G D,Zajko A B,Orons P D,et al. Detection of transjugular intrahepatic portosystemic shunt dysfunction:value of duplex Doppler sonography[J]. AJR Am J Roentgenol,1995,164(5):1119-24.
[13] Huang Q,Wu X,Fan X,et al. Comparison study of Doppler ultrasound surveillance of expanded polytetrafluoroethylene-covered stent versus bare stent in transjugular intrahepatic portosystemic shunt[J]. J Clin Ultrasound,2010,38(7):353-60.
[14] Ricci P,Cantisani V,Lombardi V,et al. Is color-Doppler US a reliable method in the follow-up of transjugular intrahepatic portosystemic shunt(TIPS)?[J]. J Ultrasound,2007,10(1):22-7.
[2]张建龙,李迎春,李松蔚,等. TIPS术后支架狭窄或闭塞的研究现状[J].世界华人消化杂志,2015,23(33):5311-7.
[3]赵世录,王昌明,傅军,等.组合支架在经颈静脉肝内门体分流术中应用的随访结果[J].中国微创外科杂志,2018,4(1):294-7.
[4] Young Y,Scanlon P,Sherestha P,et al. Duplex ultrasound versus clinical surveillance in the prediction of TIPS malfunction placed for refractory ascites:is ultrasound surveillance useful?[J]. Cardiovasc Intervent Radiol,2017,40(17):1861-5.
[5] Benito A,Bilbao J,Hernández T,et al. Doppler ultrasound for TIPS:does it work?[J]. Abdom Imaging,2004,29(1):45-52.
[6] Nicolas C,Le Gouge A,d'Alteroche L,et al. Evaluation of Doppler-ultrasonography in the diagnosis of transjugular intrahepatic portosystemic shunt dysfunction:a prospective study[J]. World J Hepatology,2017,9(27):1125-32.
[7] Engstrom B I,Horvath J J,Suhocki P V,et al. Covered transjugular intrahepatic portosystemic shunts:accuracy of ultrasound in detecting shunt malfunction[J]. AJR Am J Roentgenol,2013,200(4):904-8.
[8] Wen J M,Gaba R C. Transjugular intrahepatic portosystemic shunt dysfunction:concordance of clinical findings,Doppler ultrasound examination,and shunt venography[J]. J Clin Imaging Sci,2016,6(3):1-7.
[9]张铠,赵卫. TIPS联合胃冠状静脉栓塞治疗肝硬化门静脉高压伴上消化道出血[J].介入放射学杂志,2017,7(1):601-6.
[10] Dariushnia S R,Haskal Z J,Midia M,et al. Quality improvement guidelines for transjugular intrahepatic portosystemic shunts[J]. J Vasc Interv Radiol,2016,27(1):1-7.
[11] Carr C E,Tuite C M,Soulen M C,et al. Role of ultrasound surveillance of transjugular intrahepatic portosystemic shunts in the covered stent era[J]. J Vasc Interv Radiol,2006,17(8):1297-305.
[12] Dodd 3rd G D,Zajko A B,Orons P D,et al. Detection of transjugular intrahepatic portosystemic shunt dysfunction:value of duplex Doppler sonography[J]. AJR Am J Roentgenol,1995,164(5):1119-24.
[13] Huang Q,Wu X,Fan X,et al. Comparison study of Doppler ultrasound surveillance of expanded polytetrafluoroethylene-covered stent versus bare stent in transjugular intrahepatic portosystemic shunt[J]. J Clin Ultrasound,2010,38(7):353-60.
[14] Ricci P,Cantisani V,Lombardi V,et al. Is color-Doppler US a reliable method in the follow-up of transjugular intrahepatic portosystemic shunt(TIPS)?[J]. J Ultrasound,2007,10(1):22-7.
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