经肝中静脉TIPS技术：肝静脉与门静脉空间关系和距离的CT影像研究

doi:10.3877/cma.j.issn.2095-5782.2025.03.007

目的

在CT影像上，模拟经颈静脉肝内门体分流术（TIPS）中经肝中静脉穿刺点、肝右静脉穿刺点分别与门静脉右支穿刺点之间的空间关系、穿刺距离和层面重合度，以提高TIPS术中经肝静脉穿刺门静脉的成功率。

方法

回顾性分析中山大学附属第三医院2023年12月至2024年4月，接受腹部增强CT检查肝硬化患者的临床资料及CT影像。通过构建坐标系，分别对TIPS 穿刺过程中经肝中静脉和肝右静脉穿刺点（A点）与门静脉穿刺点（B点）的空间位置、穿刺距离及A点与门静脉右支的层面重合度进行统计分析。

结果

本研究共纳入肝硬化患者84例。选择肝中静脉作为A点时，B点位于背侧的比例高于选择肝右静脉作为A点时（P<0.05）。当选择肝中静脉作为A点时，穿刺距离较选择肝右静脉作为A点时更短（P<0.05）。当选择肝中静脉作为A点时，层面重合度较选择肝右静脉作为A点时更高（P<0.05）。

结论

从肝硬化患者CT图像上可以看出，经肝中静脉穿刺门静脉右支起始部比经肝右静脉穿刺门静脉右支起始部穿刺路径更短、层面重合度更高，有望提高TIPS术中穿刺的成功率、降低穿刺并发症。

关键词: 肝静脉, 门静脉, 门静脉高压, 门体分流术

Objective

This study aims to investigate the spatial relationship, puncture path distance, and plane overlap between hepatic veins and portal vein in simulated transjugular intrahepatic portosystemic shunt (TIPS) procedures based on CT images, in order to improve the success rate of puncture procedure during TIPS.

Methods

This retrospective study was conducted from December 2023 and April 2024 in patients with cirrhosis, who underwent abdominal contrast-enhanced CT. A Right-Anterior-Superior three-dimensional spatial coordinate system was established to analysis the spatial relationship and distance between middle or right hepatic vein (points A) and right portal trunk (point B). The spatial positions, puncture path distance between the hepatic vein puncture point (point A) and the portal vein puncture point (point B) during TIPS, as well as the plane overlap between point A and the right portal vein branch, were statistically analyzed.

Results

A total of 84 cirrhotic patients were analyzed retrospectively. Point B was more frequently located posterior to point A when the middle hepatic vein was chosen as point A compared to the right hepatic vein (P<0.05). When choosing middle hepatic vein as point A, the puncture path distance path would be shorter (P<0.05). Additionally, the plane overlap was greater when the middle hepatic vein was selected as point A than when the right hepatic vein was chosen (P<0.05).

Conclusion

Based on CT images of cirrhotic patients, puncturing the origin of the right portal vein branch via the middle hepatic vein results in a shorter puncture path and higher plane overlap compared to using the right hepatic vein. These findings have the potential to improve the success rate of puncture techniques during TIPS procedures and reduce puncture-related complications.

Key words: Hepatic vein, Portal vein, Portal hypertension, Portosystemic shunt

图1 患者筛选的流程图

图2 肝静脉右-前-上三维空间坐标系模式图 R: right; A: anterior; S: superior.

图3 图像坐标系IJK转换为解剖坐标系RAS的公式

图4 将CT影像以DICOM格式导入3D Slicer软件后的工作界面截图注：4A：轴位图像；4B：冠状位图像；4C：矢状位图像。

图5 同一患者的CT冠状面图像。A：冠状面图像显示肝中静脉穿刺点（*）与门静脉右支（箭）呈“点-线”关系；B：冠状面图像显示肝右静脉穿刺点（*）与门静脉右支（箭）呈“点-点”关系。

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TIPS via middle hepatic vein: investigation of spatial relationship and distance between hepatic veins and portal vein based on CT images

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TIPS via middle hepatic vein: investigation of spatial relationship and distance between hepatic veins and portal vein based on CT images