Objective: To assess the feasibility and value of real-time image fusion technique guiding the procedure of transjugular intrahepatic portosystemic shunt(TIPS). Methods: From July 2017 to May 2018,a total of 48 consecutive patients complicated by portal venous hypertension due to cirrhosis who underwent TIPS were prospectively allocated into two groups that 27 cases underwent normal TIPS and 21 cases underwent image fusion guided TIPS. There were 25 males and 23 females with a mean age of 29-74(51±10) years. The differences of portal vein(PV) between image fusion angiographyand digital subtraction angiography(DSA), and the times of puncture PV, X-ray exposure dose and exposure time and contrast agent amount of all cases were collected and analyzed. Results: The longitudinal and traverse difference of PV between image fusion angiography and DSA were 1.7-2.5(2.1±0.2) mm and 0.9-1.8(1.4±0.3) mm, respectively.The times of puncture PV, X-ray exposure time and dose, and contrast agent amount between normal TIPS group and image fusion guided TIPS group were 1-7(3.8±0.6) times vs 1-3(2.0±0.6) times, 41-63(53±8)min vs 27-42(35±5) min, 513-787(644±96) mGy vs 357-524(423±59) mGy,102-196(151±23) ml vs 87-145(105±14) ml(all P<0.05), respectively. Conclusions: There are minor differences between image fusion angiography of PV and DSA. Real-time image fusion guided TIPS is feasible and valuable to reduce intraprocedural X-ray exposure time and dose and contrast agent amount of TIPS.
目的： 评价全程实时影像融合技术引导经静脉肝内门体分流术（TIPS）的可行性与临床价值。 方法： 回顾性收集2017年7月至2018年5月郑州大学第一附属医院东院区介入手术室完成的肝硬化门静脉高压TIPS患者48例，男25例、女23例，年龄29~74（51±10）岁，分常规TIPS组27例，影像融合TIPS组21例，记录和测量门静脉影像融合图像与数字减影血管造影（DSA）的误差，并分别记录两组的门静脉穿刺次数、对比剂用量、X线曝光量及曝光时间。 结果： 影像融合图像与DSA图像纵向误差1.7~2.5（2.1±0.2）mm，横向误差0.9~1.8（1.4±0.3）mm；常规TIPS组及影像融合TIPS组的门静脉穿刺次数、X线曝光时间、曝光量及对比剂用量分别为1~7（3.8±0.6）比1~3（2.0±0.6）次，41~63（53±8）比27~42（35±5）min，513~787（644±96）比357~524（423±59）mGy，102~196（151±23）比87~145（105±14）ml。两组门静脉穿刺次数、X线曝光时间、曝光量及对比剂用量差异均有统计学意义（均P<0.05）。 结论： 影像融合图像与DSA图像误差较小。影像融合技术引导TIPS是安全可行的，可以减少术中穿刺次数，缩短X曝光时间及曝光量，减少对比剂用量。.
Keywords: Angiography; Image fusion technique; Portasystemic shunt, transjugular intrahepatic; Radiology, interventional.