ObjectiveTo evaluate the value of individualized preoperative simulation in transjugular intrahepatic portosystemic shunt (TIPS).MethodsThin slice scan data of 39 patients with supine upper abdomen were obtained, three dimensional structures of bone, liver, portal vein, inferior vena cava and hepatic vein in CT scan area were reconstructed in Mimics software. According to the size of interventional instruments, a virtual RUPS-100 puncture kit and an VIATORR stent were established in 3D MAX software. Computer simulations were performed to evaluate the route from the hepatic vein puncture portal vein and stent release position. The coincidence of simulation parameters with actual surgical results was compared.Results① The time of preoperative simulation was controllable. The total simulation time was 70–110 minutes (after summing up the previous experience). Preoperative simulation in daily work would not affect the progress of treatment. ② There were 4 cases of puncturing bifurcation of portal vein, 22 cases of puncturing left branch and 13 cases of puncturing right branch during operation (24 cases of puncturing left branch and 15 cases of puncturing right branch by preoperative simulation plan). The overall coincidence rate was 89.7% (35/39). ③ Preoperative simulations were performed using 8 mm×6 cm/2 cm size VIATORR stents, and the stents used in the actual operation were the same as the simulation results. ④ Preoperative simulation and post-operative retrospective simulation could shortened the teaching and training time and enhanced the understanding of surgical intention and key steps.ConclusionPreoperative simulation based on patient's individualized three-dimensional model and virtual interventional device could guided the actual operation of TIPS more accurately, and had practical value for improving the success rate of operation and training young doctors.
Transjugular intrahepatic portosystemic shunt (TIPS) has been used in the treatment of cirrhotic portal hypertension for more than 30 years. With the development of stent technology and clinical practice technology, TIPS is becoming more and more perfect in the treatment of portal hypertension. From the single-use of bare stent in the past to the application of bare stent combined with coated stent or particular Viatorr stent, the patency of stent has been significantly improved. In addition, the selection of stent caliber and the puncture part of shunt gradually reduces the occurrence of hepatic encephalopathy, liver failure and other complications caused by excessive shunt. TIPS technology has the advantages of minimally invasive, safe and reducing portal vein pressure. It has gradually become one of the primary surgical methods in the treatment of portal hypertension, esophagogastric variceal bleeding, intractable ascites, and so on.