探讨三维可视化技术引导下经颈静脉肝内门体分流术（TIPS）在巴德-吉亚利综合征（BCS）治疗中的安全性及疗效。

回顾性分析2017年1月至2021年2月在徐州医科大学附属医院行TIPS治疗的32例肝静脉广泛闭塞型BCS患者临床资料。其中男14例，女18例；平均年龄（40±14）岁。患者均签署知情同意书，符合医学伦理学规定。根据TIPS引导方式不同，将患者分为三维可视化组（可视化组，11例），直接门静脉造影组（直接造影组，10例）及间接门静脉造影组（间接造影组，11例）。观察3组穿刺效果和安全性。3组门静脉穿刺次数、穿刺时间比较采用单因素方差分析和LSD-t检验。首次通畅率比较采用Kaplan-Meier法和Log-rank检验。

32例患者均成功施行TIPS。可视化组和直接造影组均能获得清晰的门静脉影像，间接造影组2例患者门静脉左、右分支显影不清晰。可视化组、直接造影组和间接造影组门静脉穿刺次数分别为（2.8±1.0）、（3.1±1.3）、（4.8±2.4）次，穿刺时间分别为（18±14）、（26±8）、（42±18）min。可视化组门静脉穿刺次数以及穿刺时间均明显少于间接造影组（LSD-t=-3.510，-3.953；P<0.05）。可视化组和间接造影组无发生术后并发症，直接造影组肝被膜下出血1例。3组患者1年首次通畅率分别为100.0%、90.0%、90.9%，差异无统计学意义（χ²=0.069，P>0.05）。随访期间3组患者术后发生支架内再狭窄各1例，经球囊扩张后均再次通畅；可视化组和直接造影组发生Ⅰ级肝性脑病各1例，均经保守治疗后好转。

对于肝静脉广泛闭塞型BCS，三维可视化引导下TIPS是一种安全，可行的无创性方法，具有定位精准、门静脉穿刺次数少、穿刺时间短等优势，具有较好的临床应用价值。

To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) guided by three-dimensional visualization technology in the treatment of Budd-Chiari syndrome (BCS).

Clinical data of 32 patients with BCS with extensive hepatic vein obliterans undergoing TIPS in the Affiliated Hospital of Xuzhou Medical University from January 2017 to February 2021 were retrospectively analyzed. Among them, 14 patients were male and 18 female, age (40±14) years old on average. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the different guided methods of TIPS, all patients were divided into thethree-dimensional visualization group (visualization group, n=11), direct portography group (direct portography group, n=10) and indirect portography group (indirect portography group, n=11). The puncture effect and safety were observed among three groups. The quantity of portal vein puncture and puncture time were compared among three groups by using one-way ANOVA and LSD-t test. The initial patency rate was statistically compared by Kaplan-Meier method and Log-rank test.

All 32 patients successfully underwent TIPS. Portal vein could be clearly displayed in the visualization group and direct portography group, whereas the left and right branches of portal vein in 2 patients could not be explicitly displayed in the indirect portography group. In the visualization, direct portography and indirect portography groups, the quantity of portal vein puncture was (2.8±1.0), (3.1±1.3) and (4.8±2.4) times, and the puncture time was (18±14), (26±8) and (42±18) min, respectively. The quantity of portal vein puncture and puncture time in the visualization group were significantly shorter compared with those in indirect portography group (LSD-t=-3.510, -3.953;P<0.05). No postoperative complications were observed in the visualization and indirect portography groups, and subcapsular hemorrhage occurred in 1 case in the direct portography group. The initial patency rate within postoperative 1-year was 100.0%, 90.0% and 90.9% in three groups, respectively. No significant difference was noted (χ²=0.069,P>0.05). During the postoperative follow-up, 1 case of in-stent restenosis was reported in each group, and all were treated with balloon dilatation. 1 case of grade Ⅰ hepatic encephalopathy was found in the visualization and direct portography group respectively, who were alleviated after conservative treatments.

TIPS guided by three-dimensional visualization is a safe and feasible noninvasive treatment for BCS with extensive hepatic vein obliterans. It possesses multiple advantages of accurate localization, low quantity of portal vein puncture and short puncture time, which has high application value in the clinical practice.