经颈静脉肝内门体分流术（TIPS）后血流动力学分析

经颈静脉肝内门体分流术(TIPS)是通过覆膜支架将门静脉和肝静脉直接相连，让部分门脉血流不经肝脏解毒直接进入肝静脉，以缓解门静脉高压。然而，血栓导致的支架闭塞、过多门脉血液直接进入体循环诱发的肝性脑病和急性肝功能衰竭等并发症一直是其没有解决的问题。TIPS术基本原理是血流的分流，它必然会带来肝循环血流动力学的改变。申请人认为，血流动力学改变是导致这些术后综合症的重要原因，因此只能通过TIPS术的血流动力学优化加以解决，而获取个性化的分流道分流量平衡点则是其关键。遗憾的是，这些问题至今没有人研究。为此，本课题将研究：1）分流道建立以后，肝血管床血流动力学的变化规律；2）支架血管内的血流流场会如何影响血小板激活/粘附、诱发血栓；3）血流动力学改变如何影响肝血管床(包括肝窦)重塑。通过这些研究，建立个性化的分流道分流量优化方法。本课题不仅具有重要理论意义，还可为TIPS手术规划提供借鉴和依据。

Transjugular intrahepatic portosystemic shunt (TIPS) is to deploy a covered-stent graft to directly connect the portal vein and the hepatic vein, diverting part of the portal blood flow to the hepatic vein without liver detoxification so as to relieve portal hypertension. However, complications such as stent occlusion caused by thrombus, hepatic encephalopathy and acute liver failure induced by excessive portal blood directly entering the systemic circulation have been unresolved. The basic principle of TIPS is the shunt of blood flow, which will inevitably result in hemodynamic changes in the hepatic circulation. The applicant believes that hemodynamic changes are an important cause of these postoperative complications, so they can only be solved by the hemodynamic optimization of TIPS, and obtaining a personalized shunt and flow balance point is the key. Unfortunately, up to now, these issues have not yet been studied. To this end, the current study will investigate:1) How will the hemodynamics of the hepatic circulation change after the establishment of the shunt? 2) how the blood flow field in the stent will affect platelet activation / adhesion and induce thrombosis; 3) How will the hemodynamic changes affect the remodeling of the hepatic circulation including hepatic sinus. Through these studies, a personalized shunt flow optimization method will be established. This study not only has important theoretical significance, but also will provide reference and basis for TIPS surgery planning.