Walser E M, Harris V M, Harman J T, Park H M, Siddiqui A R
Department of Radiology, University of Texas Medical Branch, Galveston 77555-0709, USA.
J Vasc Interv Radiol. 1996 Mar-Apr;7(2):263-7. doi: 10.1016/s1051-0443(96)70775-3.
To quantify portosystemic shunting and hepatic portal perfusion after placement of a transjugular intrahepatic portosystemic shunt (TIPS).
Technetium-99m macroaggregated albumin (MAA) was injected directly into the portal veins of nine asymptomatic patients 3 months after TIPS placement. Portosystemic shunting was quantified by comparing counts in the lungs with those in the liver. One cirrhotic patient and one healthy patient who received portal MAA injections were used as controls.
No portosystemic shunting was found in the healthy patient. In the cirrhotic control patient, 77% of the injected activity was in the lungs. Patients with portosystemic shunts had even more activity in the lungs. Even stenotic shunts diverted greater than 80% of portal blood flow systemically. Flow through the TIPS ranged from 84% to 100% (average, 93%); these fractions of flow correlated inversely with portosystemic pressure gradients.
Cirrhotic livers may divert much of the portal blood systemically before TIPS placement. Afterward, this proportion rises, and most portal flow is diverted into the pulmonary circulation.
量化经颈静脉肝内门体分流术（TIPS）置入术后的门体分流及肝门静脉灌注情况。
在9例无症状患者TIPS置入术后3个月，将99m锝标记的大颗粒白蛋白（MAA）直接注入门静脉。通过比较肺部与肝脏的计数来量化门体分流。1例肝硬化患者和1例接受门静脉MAA注射的健康患者作为对照。
健康患者未发现门体分流。在肝硬化对照患者中，77%的注入活性物质存在于肺部。存在门体分流的患者肺部的活性物质更多。即使是狭窄的分流也会使超过80%的门静脉血流发生体循环分流。通过TIPS的血流量范围为84%至100%（平均93%）；这些血流量分数与门体压力梯度呈负相关。
肝硬化肝脏在TIPS置入术前可能会使大部分门静脉血流发生体循环分流。术后，这一比例会升高，且大部分门静脉血流会分流至肺循环。
