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目的 :通过经直肠 99m Tc O-4 门脉闪烁显像法评估分流率 (SI)与支架口径的关系 ,并观察经颈静脉肝内门体分流术 (TIPSS)对肝血流动力学的影响。方法 :选健康杂种犬 1 9只 ,制做门脉高压模型。在 TIPSS前后经直肠注入 99m Tc O-4 ,用 SPECT测分流率 (SI)及肝、心放射性活性 (RI)。通过统计学处理计算出 SI与支架口径的关系。结果 :SI与支架口径呈直线相关 ,回归方程 :Y=0 .30 1 +0 .2 2 1 X,相关系数 0 .985,经 t检验 P<0 .0 5。 TIPSS术后分流道狭窄或闭塞 ,SI升高 ,心、肝放射性活性比值 (H/L)升高。结论 :分流率在 40 %时用 1 0 mm口径支架 ;分流率在 30 %～40 %时用 8mm口径支架 ;分流率在 30 %以下时用 6mm口径支架。99m Tc O-4 门脉闪烁显像法可以检测 TIPSS术后分流道的开存性。
OBJECTIVE: To evaluate the relationship between shunting rate (SI) and scaffold caliber by transrectal 99m Tc O-4 portal scintigraphy and to observe the effects of transjugular intrahepatic portosystemic shunt (TIPSS) on hepatic hemodynamics . Methods: A total of 19 healthy mongrel dogs were selected to make portal hypertension model. 99m Tc O-4 was injected into the rectum before and after TIPSS, and SI and liver and heart radioactivity (RI) were measured by SPECT. The relationship between SI and scaffold caliber was calculated by statistical analysis. Results: The SI was linearly related to the diameter of stent. The regression equation was: Y = 0.30 1 +0 .2 2 1 X, the correlation coefficient was 0.985, P <0. 05 by t test. TIPSS shunt stenosis or occlusion, SI increased heart and liver radioactivity ratio (H / L) increased. CONCLUSIONS: A 10 mm caliber scaffold was used at a 40% split rate, an 8 mm caliber scaffold at a 30% -40% split rate, and a 6 mm caliber scaffold at a split rate less than 30%. 99m Tc O-4 portal scintigraphy can detect the survival of the shunt after TIPSS.