本文選題：經頸靜脈肝內門-體分流術 + 門靜脈高壓�。� 參考：《重慶醫(yī)科大學》2014年碩士論文

【摘要】：第一部分剪切波速度無創(chuàng)評估TIPS分流術療效的臨床研究 目的應用聲觸診組織量化(virtual touch tissue quantification，VTQ)技術測量肝臟剪切波速度(liver shear wave speed，LSWS)值和脾臟剪切波速度(spleen shear wave speed，SSWS)值，探討該技術無創(chuàng)評估經頸靜脈肝內門-體（Transjugular Intrahepatic Portosystemic Shunt，TIPS）分流術術后療效的可行性。 方法應用VTQ技術對20例健康志愿者和24例肝硬化門靜脈高壓預行TIPS分流術患者進行LSWS值和SSWS值的測量；并于手術同時測量門靜脈壓力（Portal vein pressure Gradient，PPG）；比較手術前、后LSWS值和SSWS值的變化以及變化趨勢，并分析兩者與門靜脈壓力的相關性；同時對14例患者進行術后1個月的隨訪。 結果PPG在TIPS分流術前、后的差異有統(tǒng)計學意義（P 0.001）；LSWS值和SSWS值在正常對照組與TIPS分流術組間的差異均有統(tǒng)計學意義（P均0.001）；TIPS分流術前、后的LSWS值比較差異沒有統(tǒng)計學意義（P=0.130），但是SSWS值比較差異有顯著的統(tǒng)計學意義（P0.001）。14例隨訪患者的LSWS值在術前、術后1w、術后1m中兩兩比較差異均無統(tǒng)計學意義（P均0.05）；而SSWS值兩兩比較差異均有統(tǒng)計學意義（P均0.05）。Spearman秩相關分析顯示，LSWS值與PPG無相關性（r=0.154，P=0.296），而SSWS值與PPG呈高度正相關（r=0.602，P0.001）。 結論VTQ技術測量的SSWS值可作為無創(chuàng)評估門靜脈壓力的有效指標，定量監(jiān)測術后門靜脈壓力的變化，進而評估其手術療效；但目前還未發(fā)現(xiàn)LSWS值可以用于評估其手術療效。 第二部分剪切波速度無創(chuàng)預測肝硬化食管靜脈曲張出血風險的臨床研究 目的應用聲觸診組織量化(virtual touch tissue quantification，VTQ)技術測量肝臟剪切波速度(liver shear wave speed，，LSWS)值和脾臟剪切波速度(spleen shear wave speed，SSWS)值，并探討LSWS值和SSWS值無創(chuàng)預測食管靜脈曲張破裂出血(Esophageal Variceal Bleeding，EVB)風險的臨床價值。 方法應用VTQ技術對99例受試者分別測量LSWS值及SSWS值,包括30例健康志愿者(對照組)、69例臨床診斷的乙型肝炎肝硬化患者且經過胃鏡證實都患有不同程度的食管靜脈曲張(其中有食管靜脈曲張破裂出血的36例，無出血的33例)；檢查肝生化指標；將各組所得的LSWS值及SSWS值進行比較,并分析LSWS、SSWS值與食管靜脈曲張出血風險的關系。 結果LSWS值和SSWS值在正常對照組和非出血組間的差異均有統(tǒng)計學意義（P均0.001）。出血組與非出血組間的LSWS值比較差異無統(tǒng)計學意義(P=0.158)，LSWS值與EVB風險無相關性(P=0.164)；但是SSWS值在兩組間比較差異有統(tǒng)計學意義(P0.001),且SSWS值與EVB風險呈顯著相關，相關系數(shù)r=0.73（P0.05）。SSWS值診斷肝硬化食管靜脈曲張破裂出血風險的臨界值為3.54m/s時，靈敏度、特異度分別為81.3%、84.6%， AUROC (area under receiver operatingcharacteristic curve)為0.894。 結論聲觸診組織量化技術測量的SSWS值可無創(chuàng)預測肝硬化患者食管靜脈曲張破裂出血的風險，但還未發(fā)現(xiàn)LSWS值與食管靜脈曲張破裂出血的風險有相關性。
[Abstract]:Part one clinical study of the effect of shear wave velocity on noninvasive evaluation of TIPS shunt
Objective to measure the value of the liver shear wave velocity (liver shear wave speed, LSWS) and the splenic shear wave velocity (spleen shear) by virtual touch tissue quantification (VTQ). S) the feasibility of the curative effect after the shunt.
Methods the LSWS and SSWS values of 20 healthy volunteers and 24 patients with cirrhosis of the portal hypertension were measured by VTQ technique, and the portal vein pressure (Portal vein pressure Gradient, PPG) was measured at the same time, and the changes and trends of the value and LSWS value and SSWS value before the operation were compared, and the two were analyzed and analyzed. The correlation of venous pressure was observed, and 14 patients were followed up for 1 months after operation.
Results the difference between PPG and TIPS was statistically significant (P 0.001), and the difference between LSWS and SSWS was statistically significant (P 0.001) between the normal control group and the TIPS shunt group (P all), and there was no statistical significance (P= 0.130) before TIPS shunt (P= 0.130), but there was significant difference between the SSWS value (P). 0.001) the LSWS value of.14 follow-up patients was not statistically significant before operation, 1W after operation and 22 in 1m after operation (P 0.05), while SSWS value 22 was statistically significant (P 0.05).Spearman rank correlation analysis showed that LSWS value was not correlated with PPG (r= 0.154, P=0.296).
Conclusion the SSWS value measured by VTQ can be used as an effective index for noninvasive assessment of portal pressure. The changes of portal vein pressure after the operation are monitored and the effect of the operation is evaluated. However, the LSWS value has not been found to be used to evaluate the effect of the operation.
The second part is a noninvasive prediction of esophageal variceal bleeding risk of cirrhosis with shear wave velocity.
Objective to measure the liver shear wave velocity (liver shear wave speed, LSWS) and splenic shear wave velocity (spleen shear) by virtual touch tissue quantification (VTQ), and to explore the value and non invasive prediction of esophageal variceal bleeding. The clinical value of risk.
Methods VTQ technique was used to measure the value of LSWS and SSWS in 99 subjects, including 30 healthy volunteers (control group), 69 cases of hepatitis B liver cirrhosis, and 69 cases with different degrees of esophageal varices (including 36 cases of esophageal varices bleeding, 33 cases without bleeding). The LSWS value and SSWS value of each group were compared, and the relationship between LSWS and SSWS value and the risk of esophageal varices bleeding was analyzed.
Results there was significant difference between the LSWS value and the SSWS value between the normal control group and the non hemorrhagic group (P 0.001). There was no significant difference in the LSWS value between the bleeding group and the non hemorrhagic group (P=0.158), and the LSWS value was not correlated with the EVB risk (P=0.164), but the SSWS values were statistically significant between the two groups (P0.001), and the SSWS value was compared with E. The risk of VB was significantly correlated. The critical value of the correlation coefficient r=0.73 (P0.05).SSWS value in diagnosing the risk of esophageal variceal bleeding was 3.54m/s, and the sensitivity was 81.3%, 84.6%, AUROC (area under receiver operatingcharacteristic curve) was 0.894..
Conclusion the SSWS value measured by acoustic palpation tissue quantification technique can not predict the risk of esophageal variceal bleeding in patients with cirrhosis, but there is no correlation between the risk of LSWS and the risk of bleeding of esophageal varices.

【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.1;R654.3

【參考文獻】

相關期刊論文 前7條

1 劉迎迎;任為國;;Fibroscan在預測肝硬化食管靜脈曲張程度及出血中的作用[J];當代醫(yī)學;2014年01期

2 賀慶紅;黃蔚;;肝硬化食管靜脈曲張破裂出血患者門靜脈血流參數(shù)的變化[J];臨床薈萃;2014年03期

3 劉維國;鄭勇;陳衛(wèi)剛;;門靜脈壓力測定方法研究現(xiàn)況[J];現(xiàn)代生物醫(yī)學進展;2009年16期

4 蔣曉渠;陳世耀;王慧;;食管胃靜脈曲張破裂出血患者死亡危險因素分析[J];胃腸病學;2011年02期

5 魏國;溫賢敏;蒲育;田浩;張振蘭;王林;范合璋;何敏;;彩色多普勒預測食管靜脈曲張程度與出血風險的價值[J];中國實用醫(yī)藥;2009年06期

6 張軍;鄧克學;;能譜CT預測肝硬化門靜脈高壓患者并發(fā)食管靜脈曲張破裂出血風險[J];中國醫(yī)學影像技術;2012年12期

7 張鑫;孫浩;許金衛(wèi);;肝硬化門脈高壓患者食管靜脈曲張CT表現(xiàn)預測首次上消化道出血的風險[J];中華臨床醫(yī)師雜志(電子版);2013年16期

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