Zheng Lei, Wu Guangbo, Lin Jiayun, Li Hongjie, Zhang Chihao, Zhao Zhifeng, Chen Min, Wu Zhenghao, Luo Guqing, Fan Qiang, Qi Xiaoliang, Huo Haizhong, Sun Longci, Luo Meng
Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China.
Department of Gastrointestinal Surgery, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China.
Trials. 2025 May 21;26(1):167. doi: 10.1186/s13063-025-08818-6.
To introduce and assess a novel method for portal pressure measurement based on biofluid mechanics in portal hypertensive patients undergoing surgery.
The research was a multi-center, retrospective study, conducted on patients who underwent surgery and measurement of free portal pressure (FPP). There were 118 patients included and 21 patients excluded due to the failure or poor results of Doppler ultrasound, and 97 patients were screened. We used patients' CT images, Doppler ultrasound results of the portal system, blood density and viscosity to reconstruct their portal system and simulate its internal blood flow. According to the patient's physical property, geometry, and boundary conditions, the Navier-Stokes equations were solved by FLUENT software, and virtual free portal pressure (vFPP) was calculated. Finally, the Bland-Altman Limits of Agreement, intraclass correlation coefficient (ICC), and the Lin's concordance correlation coefficient were performed to evaluate the numerical correlation between the vFPP and FPP.
All patients enrolled in this study underwent the surgery, and the FPP of patients was measured during the surgery, with a mean FPP of 22.8 ± 3.3 mmHg (range: 13-33 mmHg). Meanwhile, according to computational biofluid mechanics, all patients' vFPP was calculated. Then, we further explored whether there was a close relationship between vFPP and FPP in the whole population. For the analysis of Bland-Altman Limits of Agreement, the mean value of difference was - 0.1569 (95% CI: - 0.4305 to 0.1167); lower limit of agreement: - 2.8176 (95% CI: - 3.2868 to - 2.3484); upper limit of agreement: 2.5038 (95% CI: 2.0346 to 2.9730). The ICC was 0.9215 (95% CI: 0.8848 to 0.9468). Furthermore, the Lin's concordance correlation coefficient showed a numerical correlation between the vFPP and FPP, which was 0.9205 (95% CI: 0.8840 to 0.9459). All these results confirmed that our vFPP model could provide an accurate prediction of FPP in patients.
The vFPP of patients calculated by computational biofluid mechanics was significantly correlated with the FPP of portal hypertensive patients, which would be a novel, non-invasive, and accurate method for the assessment of portal pressure in surgical patients.
介绍并评估一种基于生物流体力学的门静脉压力测量新方法，用于接受手术的门静脉高压患者。
本研究为多中心回顾性研究，针对接受手术并测量自由门静脉压力（FPP）的患者开展。共纳入118例患者，21例因多普勒超声检查失败或结果不佳被排除，最终筛选出97例患者。我们利用患者的CT图像、门静脉系统的多普勒超声结果、血液密度和黏度重建其门静脉系统，并模拟其内部血流。根据患者的物理特性、几何形状和边界条件，使用FLUENT软件求解Navier-Stokes方程，计算虚拟自由门静脉压力（vFPP）。最后，采用Bland-Altman一致性界限、组内相关系数（ICC）和Lin一致性相关系数评估vFPP与FPP之间的数值相关性。
本研究纳入的所有患者均接受了手术，并在手术期间测量了患者的FPP，平均FPP为22.8±3.3 mmHg（范围：13 - 33 mmHg）。同时，根据计算生物流体力学方法，计算出所有患者的vFPP。然后，我们进一步探讨了整个人群中vFPP与FPP之间是否存在密切关系。对于Bland-Altman一致性界限分析，差异均值为 - 0.1569（95%CI： - 0.4305至0.1167）；一致性下限： - 2.8176（95%CI： - 3.2868至 - 2.3484）；一致性上限：2.5038（95%CI：2.0346至2.9730）。ICC为0.9215（95%CI：0.8848至0.9468）。此外，Lin一致性相关系数显示vFPP与FPP之间存在数值相关性，为0.9205（95%CI：0.8840至0.9459）。所有这些结果证实，我们的vFPP模型能够准确预测患者的FPP。
通过计算生物流体力学计算出的患者vFPP与门静脉高压患者的FPP显著相关，这将是一种用于评估手术患者门静脉压力的新颖、非侵入性且准确的方法。
