声触诊组织量化技术无创评价经颈静脉肝内门-腔分流术疗效的可行性研究

摘要

目的 探讨声触诊组织量化(virtual touch tissue quantification,VTQ)技术无创评价经颈静脉肝内门-腔分流术(transjugular intrahepatic portosystemic stent shunt,TIPSS)疗效的可行性.方法 应用VTQ技术对24例肝硬化门静脉高压预行TIPSS分流术患者分别测量手术前后肝、脾剪切波速度(shear wave velocity,SWV);并于手术时测量门静脉压力(portosystemic pressure gradient,PPG)；比较手术前后肝、脾SWV值的变化及与PPG的相关性.同时对14例患者进行术后1个月的随访.结果 PPG 和脾SWV值在手术前为(27.87±4.68) mm Hg和(3.49±0.40) m/s,术后为(16.46±3.76) mm Hg和(3.08±0.39)rn/s,两者的差异均有统计学意义(P均＜0.05)；肝SWV值在手术前后的差异无统计学意义(P=0.130).脾SWV值与PPG呈高度正相关(r=0.602,P=0.000);肝SWV值与PPG无相关性(r=0.154,P=0.296).14例随访患者术前、术后1周、术后1个月的脾SWV值两两比较差异均有统计学意义(P均＜0.05)；而肝SWV值两两比较差异均无统计学意义(P均＞0.05).结论 VTQ技术测量的脾SWV值可用于定量监测TIPSS分流术前后门静脉压力的变化,无创评价手术疗效,但目前还未发现肝SWV值可以用于评价其手术疗效.%Objective To explore the feasibility of virtual touch tissue quantification(VTQ) technique in noninvasive assessment of transjugular intrahepatic portosystemic stent shunt (TIPSS).Methods Twenty-four patients were enrolled in this study.Shear wave velocity(SWV) of the liver and spleen were obtained by VTQ technique on one day before TIPSS insertion and one week after TIPSS placement,and the portal vein pressure was measured while placing the TIPSS.The correlation between SWV of the liver and spleen and portal venous pressure were analysed.In addition,fourteen patients were followed up for one month after TIPSS placement.Results There was significant difference in portal vein pressure pre [(27.82 ± 4.07) mm Hg] and post [(16.26-± 3.10) mm Hg] TIPSS insertion.The SWV of the liver in patients pre and post TIPSS measured (2.43 ± 0.37)m/s and (2.40 ± 0.34)m/s,respectively.The SWV of the spleen in patients pre and post TIPSS were (3.49 ± 0.40)m/s and (3.08 ± 0.39)m/s,respectively,there was significant difference (P =0.000).However,SWV of the liver pre and post TIPSS placement was no significant difference(P =0.130).And as well as the patients which were followed up for one month after TIPSS placement.A significant,direct,linear correlation(r =0.602,P =0.000) was found between SWV of the spleen and portal vein pressure,but liver SWV was not correlated with the portal venous pressure.Conclusions SWV of the spleen measured by VTQ technique has a significant correlation with portal vein pressure.Hence,the spleen SWV based on VTQ technique can be used as a non-invasive method for quantitatively in monitoring the portal vein pressure as the function of the TIPSS.However,evidence to support a similar role for liver stiffness is lacking.