The Anatomical Basis Of TIPS

Aims: This study aimed to guide the clinical selection of TIPS puncture point through the applied anatomy of adult cadaver liver specimens and research on the CT imaging data of cirrhosis patients in clinic.Methods:Firstly,30 liver specimens of adult cadavers from the Anatomy Teaching and Research Office of our school were studied and analyzed,and all livers were bluntly dissected from the visceral surface and diaphragmatic surface,respectively,thus exposing the hepatic vein and portal vein.Anatomical data,such as the opening morphology of hepatic vein in the inferior vena cava,converging type with the inferior vena cava and the position,were observed;the relationship of portal vein furcation with Glisson's capsule was recorded;and the intrahepatic spatial position relationship of hepatic vein with portal vein was observed.Secondly,60 cirrhosis patients receiving CT examination(first plain scan and then enhanced scan)in our hospital were selected,and liver-related vessels were scanned(hepatic vein and inferior vena cava).The data obtained were processed in the post-processing workstation,and the simulated puncture pathway was measured.Finally,24 patients with cirrhotic portalhypertension accompanying with gastric-esophageal variceal rupture and bleeding or refractory ascites undergoing TIPS through that puncture point in the First Hospital Affiliated to Chongqing Medical University from October 2016 to October 2017 were collected.The preoperative and postoperative hemoglobin,liver function and changes of main portacaval pressure in these patients were compared.Moreover,the shunt channels in all patients were followed up using color doppler flow imaging(CDFI).Results:1.Angles formed by branches of left hepatic vein,right hepatic vein and middle hepatic vein were smaller than those formed by all branches of portal vein.Among the overlaps of left,right and middle hepatic veins with portal vein,the middle hepatic vein had the shortest distance to portal vein,which was 4.16±1.1mm.The portal vein branch of right lobe of liver located inferior to the right hepatic vein at a distance of8.16±5.2mm.2.CT and CT three-dimensional reconstruction suggested that,data regarding the overlaps of 3 hepatic vein branches with portal vein differed,among which,the right hepatic vein overlaps had the greatest diameter.Compared with right hepatic vein,the middle hepatic vein was closer to the hepatic portal vein,and the difference in the transverse diameter of hepatic portal vein between the two was no statistically significant.3.All the 24 patients had successfully completed TIPS.Compared with those preoperatively,the hemoglobin,liver function and changes of main portacaval pressure in patients were improved,and theshunt channels in all patients were smooth during the follow-up period.Conclusion:The best way of puncture is right hepatic vein to portal vein right trunk.The choice of puncture point is better than right hepatic vein to portal vein right trunk.The effect of TIPS on the patients with portal hypertension is good,the effect after the operation is long,and it is of very important clinical value.