| BRTO和TIPS目标是通过根本改变门静脉压力和门静脉血流动力学干预门静脉高压的并发症。BRTO理论上通过减少门静脉分流积极地增加门静脉向肝血流和潜在肝功能储备。TIPS则相反，通过分流肝实质的门静脉血流负面干预肝功能储备和向肝血流。 在以前这两项操作对全肝门静脉血流影响并不十分清楚，也没有建立的术中操作测量的成熟方法。应用量化DSA和直接血流测定可以观察和量化BRTO后肝灌注的变化。同样的方法也可以观察TIPS的影响。 即所谓用量化DSA（Q-DSA）有或没有TIPS的BRTO后到肝脏门静脉血流分析
Analysis of inline portal flow to the liver after BRTO of gastric varices in the presence and absence of a TIPS utilizing quantitative digital subtraction angiography (Q-DSA)
TIPS 术后，量化DSA用于肝灌注测量：TIPS减少向肝血流
During a specific case, the relative consequence of these procedures on total hepatic portal venous flow is unclear and methods of measuring flow intra-procedurally are not well established
Performing a TIPS & BRTO in the same setting will have an indeterminate effect on hepatic flow depending on the underlying flow rate through the shunts and the “capacitance” of the liver.
在同一情况下（in the same setting）进行TIPS和BRTO，取决于： 1. 通过分流的基本流量，和 2. 肝脏的“容量” 对肝血流有绝对性影像
TIPS reduces intra-hepatic portal venous inline blood flow
Quantitative DSA using iFlow (Siemens, Germany)
单独 BRTO前后（Patient 1）
病人1
病人4
BRTO后门静脉血流的变化不一样，这反映了栓塞前向肝血流率的差异。BRTO似乎增加门静脉血流，TIPS减少肝内门静脉血流。
Conclusions
Portal venous flow varies considerably after BRTO.
This reflects variability in flow rates within the GRS prior to embolization.
BRTO appears to increase portal flow when GRS demonstrates flows >300-900ml/min.
TIPS reduces the amplification of intrahepatic portal flow after BRTO by at least 50%.
| |||||||||||||||||||||||||||||||||||||
