| AIMS:In recent years,more and more attention has been paid to the accurate treatment of esophageal and gastric varices hemorrhage due to liver cirrhosis.To further evaluate the accuracy of embolization,it is necessary to rely on CT portal venography(CTPV)to clearly display the locations of portal vein,collateral circulation vessels and tissue adhesives.The purpose of this study is to retrospectively analyze and select 38 patients.Through the application of 3D Slicer software,which is free of charge and open to the outside world,the portal vein and its varicose veins are reconstructed in the portal phase of upper abdominal CT dynamic enhanced scanning,and the embolic position of tissue adhesive is observed,so as to judge whether the initial varicose veins of gastric fundus are embolized accurately,compare the changes of liver function indexes before and after treatment,evaluate the therapeutic effect,and further guide endoscopic treatment.Methods:Patients with decompensated cirrhosis complicated with moderate to severe esophageal and gastric fundus varices who received gastroscopic treatment for liver cirrhosis or " hematemesis and / or black stool" in the Department of Gastroenterology,Affiliated Hospital of Qingdao University from December 2015 to July2018 were collected as research subjects.CTPV examination was performed before treatment,and the main blood vessel of varices was identified as the left gastric vein.Retrospective clinical analysis was conducted.The original image data of dynamic contrast-enhanced CT scan of the upper abdomen in DICOM format is acquired through the radiology department,and the three-dimensional vascular reconstruction of dynamic contrast-enhanced CT scan of the upper abdomen is realized not through the CT three-dimensional reconstruction system of the radiology department equipment but through the support of the free and open 3D Slicer software.The vessels to be observed are: porta hepatis trunk,gastric left vein,gastric short / retrogastric vein.Results:Through 3D Slicer software,38 cases of liver cirrhosis patients with esophagogastric varices were collected and screened.After tissue adhesive injection treatment,the upper abdomen CT dynamic enhanced scanning imaging 3D vascularreconstruction confirmed that the location of tissue adhesive embolism in 38 cases was the varicose starting vein.Following up for 1-6 months,2 patients were readmitted for "black stool"(5.26%),and 3 patients were readmitted for "hematemesis with black stool"(7.89%).Compared with the Child-Pugh grade(human)of patients before and after treatment,the Child-Pugh grade of 5(13.16%)patients after operation was better than before,4(10.53%)patients after operation was worse than before,and 29(76.32%)patients after operation had the same Child-Pugh grade as before.The NICE index was improved in 15(39.47%)patients,increased in 5(13.16%)patients,and unchanged in18(47.37%)patients.By comparing the changes of various indexes before and after treatment with the paired design mean,it is concluded that albumin t=0.4780,P>0.50 has no statistical significance,total bilirubin t=-1.15547,P>0.20 has no statistical significance,glutamic pyruvic transaminase t=-1.6699,P>0.10 has no statistical significance,glutamic oxaloacetic transaminase t=-1.1506,P>0.20 has no statistical significance,glutamyltranspeptidase t=-0.68933,P>0.50 has no statistical significance.Conclusions : 3D-Slicer software is a free and open source image analysis and processing platform with powerful functions.It further evaluates the embolic position after tissue adhesive injection,and plays an important role in the treatment effect,time of re-visit and prognosis.Currently,3D-Slicer software is widely used in neurosurgery.Through a retrospective analysis of 38 patients,the application of the software to the three-dimensional vascular reconstruction of portal vein and its varicose vessels in cirrhotic patients with esophageal and gastric varices can better guide endoscopic treatment.The software has strong expansion function,and further exploration is still needed when applied to digestive medicine.The research in this paper proves that the tissue adhesive positions are effective in embolizing varicose starting veins,and the comparison of Child-Pugh grade(human)before and after treatment for patients is only10.53% more severe than before.The vast majority did not make any further progress than before.The NICE index of 13.16% of the patients was worse than before.Through the paired design average comparison,it was concluded that albumin,total bilirubin,glutamic pyruvic transaminase,glutamic oxaloacetic transaminase and glutamyl transpeptidase had no statistical significance,which further indicated that the liver function of the patients receiving treatment after tissue adhesive injection had no aggravation than before.Further in-depth research on 3D-Slicer software can not only be widely applied to neurosurgery,but also have guiding and evaluating effects on digestive endoscopy. |
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