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目的观察门静脉高压患者经颈静脉肝内门体静脉分流术(TIPS)治疗前后颈段胸导管内径的变化,探讨该变化对TIPS分流道失功能的预测价值。方法应用高频超声前瞻性检测126例门静脉高压患者TIPS治疗前后1个月颈段胸导管内径(CTDd),同期选取65例健康志愿者作为对照组。TIPS术后1、3、6、12个月对患者进行定期随访,根据分流道功能情况将患者分为通畅组及失功能组,比较TIPS治疗前后两组CTDd变化的差异。应用受试者工作特征(ROC)曲线下面积评价CTDd变化对分流道失功能的截断值及其预测能力。结果 126例肝硬化患者均成功接受TIPS治疗。随访期间TIPS支架出现再狭窄或者闭塞26例,术后1、3、6、12个月的累积通畅率分别为91%、85%、83%、79%。患者术前CTDd为(5.6±2.1)mm,与对照组相比(1.9±0.5)mm明显扩张(P<0.001)。分流道失功能组与通畅组TIPS术前CTDd差异无统计学意义(P>0.05);分流道通畅组CTDd变化率(△CTDd)较无失功能组大,差异有统计学意义(P=0.001)。当△CTDd的截断点为-15%(曲线下面积为0.751)时,其预测分流道失功能的灵敏度为81.8%、特异度为66.7%、准确度为77%。结论颈段胸导管超声内径变化可对TIPS分流道失功能有一定的预测作用。
Objective To observe the changes of the thoracic duct diameter before and after transjugular intrahepatic portosystemic venous shunt (TIPS) in patients with portal hypertension and to explore the predictive value of this change on the loss of TIPS shunt. Methods A total of 126 healthy volunteers were enrolled in this study. A total of 126 healthy volunteers were enrolled in this study. One hundred and sixty-six patients with portal hypertension were examined prospectively by CT scanning. Patients were routinely followed up 1, 3, 6 and 12 months after TIPS. According to the function of the shunt, the patients were divided into two groups: the patency group and the failure group. The differences of CTDd between the two groups before and after TIPS treatment were compared. The area under the receiver operating characteristic (ROC) curve was used to assess the cut-off value and its predictive power of CTDd changes in shunt dysfunction. Results 126 patients with liver cirrhosis were successfully treated with TIPS. TIPS stent restenosis or occlusion during follow-up 26 cases, 1,3,6,12 months after the cumulative cumulative patency rates were 91%, 85%, 83%, 79%. The preoperative CTDd was (5.6 ± 2.1) mm and significantly (1.9 ± 0.5) mm compared with the control group (P <0.001). There was no significant difference in preoperative CTDd between shunt dysfunction group and TIPS group (P> 0.05). The CTDd change rate (△ CTDd) in shunt group was significantly higher than that in non-shunt group (P = 0.001) ). When △ CTDd had a cut-off point of -15% (area under the curve 0.751), the sensitivity of predicted CTD was 81.8%, specificity was 66.7%, and accuracy was 77%. Conclusions The change of internal diameter of thoracic duct in cervical segment can predict the loss of TIPS shunt.