肝脏局灶性病变的血管造影检查

目前,肝脏局灶性病变的首次检出和定性诊断几乎只有通过超声、CT以及超声和CT导向活检才能达到。血管造影的适应范围主要限于外科手术前确定肝动脉、门静脉和肝静脉的血管解剖以及用于门静脉肿瘤种植的局部化疗或肝肿瘤的栓塞治疗。当非损伤性影象检查方法被拒用以及活检不安全时,唯有血管造影对局灶性病变的定性诊断能提供更多的信息。术前必须了解肝的动脉和静脉的血供类型,占位性病变侵犯哪个(些)段以及门静脉在肝内的分支情况。腹腔——肠系膜动脉造影、间接门静脉造影、选择性肝灌注造影、经皮经肝穿刺门静脉造影以及选择性肝静脉造影可以解决这些问题。     

经脾放射性同位素门脉造影对食管静脉瘤硬化疗法的评价

作者应用~(99m)TcO_4门脉造影对28例肝硬化的食管静脉瘤硬化疗法作了研究。放射性同位素门静脉造影于治疗前24小时内及治疗后24小时内进行。对28例放射性同位素门脉造影发现,门脉系统上行性侧枝循环为冠状静脉,下行性侧枝循环为肠系膜下静脉、脾肾静脉及脐静脉。放射性同位素门脉造影多能显示肝脏,但亦有部分不能显示。能测定血流比者为61%(17/28例)。测定结果显示硬化疗法前后血流比显示有意义的减少。放射性同位素门脉造影能显示上行性侧枝循环和肝者17例,显示上下     

螺旋CT经动脉门静脉造影及其临床应用

用螺旋ＣＴ作经动脉门静脉造影（ＣＴＡＰ）是目前检出肝内肿瘤是敏感的技术之一。用ＣＴＡＰ作多谇闰和三维重建可以清楚显示肝内静脉系统和肝静脉系统，得到肿瘤的精确定位以及肿瘤与肝内血管的关系，并对肝脏手术的切除保留肝脏的体积进行术前评估。     

进一步开展与提高门静脉系的血管成像技术

门脉系造影成像在上腹部尤其是肝脏疾病的诊疗中占有重要地位。随着外科学的发展，对门静脉系成像的要求也大为提高。门静脉因其解剖结构特点，在ＣＴ、ＭＲ问世前，需借助创伤性检查方法显示其形态。５０年代开始，先后开展了脐静脉门脉造影（ＩＵＶＰ）（开通脐静脉）、...     

脐静脉扩大——一个门脉高压的征象

出生后脐静脉就中断了血液供应,变成脐静脉索。但在患门脉高压的成人,它可能重新开放和扩张,在肝门静脉和体静脉床之间形成侧支通道之一。作者报告3例(年龄分别为44、67和79岁)肝硬化患者,在侧位胸片上见到扩张的脐静脉,位于肝脏的前下方脂肪组织中呈圆形或分叶状。用CT 增强扫描证实了每一例的血管特性并皆起源于门静脉的左支。作者指出,血管造影、CT 和超声检查都成功地用来检查疑为门脉高压的侧支血管形式。放射检查主要放在食管静脉曲张,在胸片有时形成类     

常染色体隐性遗传性多囊肾病:临床、病理与影像学表现

常染色体隐性多囊肾病是一种以肾集合管和肝内胆管扩张、畸形及肝脏和肾脏纤维化为特点的遗传性疾病。高血压、肾功能不全及门静脉高压是常见的临床症状。影像学表现为肾脏增大但保持肾的外形，超声显示肾实质呈弥漫性回声，静脉肾盂造影及增强CT显示肾脏呈纹状改变。肝脏影像学表现可正常或肝内胆管扩张，门静脉高压常表现脾脏增大和门静脉曲张.     

正常人肝内胆管和肝动脉的解剖学观察

我们在研究了肝内门静脉与肝静脉的解剖后,继续对肝内胆管和动脉系统作了研究。现将40个正常成人新鲜肝脏腐触标本的观察结果总结如下。 研究方法 一、标本的制备:为了便于观察,每个标本均以门静脉为衬托。先将新鲜肝脏的门静脉、肝     

肝性脑病与门静脉高压侧枝循环形成的关系——CT门静脉造影的监测价值

目的:评价螺旋CT门静脉造影在门体分流性肝性脑病发病风险中的价值.材料和方法:门体分流性肝性脑病患者29例,采用West Haven标准分级后行平扫及双期增强扫描,对腹腔干、门静脉、下腔静脉及其分支进行三维血管重建.结果:29例患者中,Ⅰ级以食管静脉和胃周静脉曲张为主;Ⅱ级和Ⅲ级:除Ⅰ级表现外,以脐周静脉、腹膜后静脉、食管周围静脉曲张和奇静脉扩大为主,部分有门静脉-肝动脉瘘和门静脉栓子形成;Ⅳ级出现左肾静脉扩大和胆囊周围静脉曲张,均伴门静脉-肝动脉瘘形成.结论:螺旋CT门静脉造影对门体分流性肝性脑病发病风险具有一定预测价值.     

暂时阻断肝静脉后肝脏的血流改变及其意义：CT影像学研究

目的 研究犬肝静脉阻断后肝脏血流改变,并评估该技术在肝癌介入治疗中的应用价值。材料与方法 对6只犬行肝静脉球囊导管阻断,应用螺旋CT行肝脏双期扫描和同层动态增强扫描。结果 肝静脉受阻肝叶密度明显低于未阻肝叶,二者形成明显的分界,门静脉逆行增强显影,受阻肝叶肝实质及门静脉增强的平均峰值时间显滞后于未受阻者。结论 暂时阻断肝静脉后受阻区域总的血流量减少,血流速度变缓,门静脉变为引流静脉。暂时阻断肝静脉行肝动脉化疗栓塞术和局部高温固化疗效是一项有临床应用前景的技术。     

经皮肝—门脉造影术

技术与应用X 线显示门静系统可经剖腹直接穿刺注入造影剂或行脾门脉造影、腹腔动脉或肠系膜动脉造影的静脉期、经皮肝穿刺门脉注射、经再通的脐静脉注射、和经颈静脉、经肝穿刺门静脉来进行。近年来,经皮肝一门脉造影已引起注意。在肝硬化,经皮肝门脉造影可估计血液动力学变化,观察静脉曲张及其它侧枝循环,检查门静脉及脾静脉通畅情况和观察经外科建立的门一腔静脉短路的通畅情况等。在肝大、脾大和怀疑脾门静脉通路的肿瘤也可用这种检查。门静脉系统导管术也可用于食管静脉曲张的非手术性闭塞。近来本操作还用于胰腺内分泌瘤的诊断与定位。作者从1972年开始行经皮肝门脉造影术。     

肝门静脉血流分布的多层螺旋CT研究

目的 运用多层螺旋CT研究脾静脉(SpV)和肠系膜上静脉(SMV)血流在门静脉内和肝内的分布规律,为临床提供相应的影像解剖学数据.方法 回顾性分析在重庆医科大学附属第一医院行上腹部CT平扫及增强检查,动脉期SpV强化而SMV未强化的165例患者的CT资料,观察门静脉主干内SpV与SMV血流的分布情况.分别测量平扫和增强动脉期门静脉左支(LPV)与门静脉右支(RPV)、肝脏左叶与右叶CT值;分析SpV和SMV的血流在门静脉内和肝脏内的分布区域及规律.结果 (1)SpV和SMV血流在门静脉主干内分布情况:分层分布(A组)占61.81％ (102/165);螺旋形分布(B组)占24.85％ (41/165);紊乱分布(C组)占13.33％ (22/165).(2)动脉期LPV的CT值＞RPV占84.24％(139/165),＜RPV占15.76％ (26/165),肝脏左叶CT值＞右叶占85.45％(141/165),＜右叶占14.55％ (24/165);动脉期门静脉左右支、肝脏左右叶CT值差异有显著统计学意义(P＜0.01),平扫无统计学差异(P＞0.05).A、B、C三组组内动脉期门静脉左右支、肝脏左右叶CT值差异有统计学意义(P＜0.05),平扫差异均无统计学意义.结论 SpV和SMV血流在肝门静脉内存在分层分布、螺旋形分布、紊乱分布.84.24％的患者SpV血液主要流入LPV进入肝左叶,SMV血液主要流入RPV进入肝右叶.     

动脉期左侧卵巢静脉显示及其临床意义

目的:分析动脉期左侧卵巢静脉显示与临床相关因素的关系,探讨其临床意义。材料和方法:对93例病人进行CTA检查,使用Toshiba16层CT,层厚1mm,螺距15,造影剂注射速度3.5ml/s或4.0ml/s,注射后26s开始扫描,获得数据进行横断面测量和三维容积成像分析,并与患者的患病情况、生育次数和初潮年龄等因素进行相关分析。结果:三维图像动脉期左侧卵巢静脉的显示率与其直径的大小成正比。动脉期左侧卵巢静脉的显示率与患者有无妇科疾病和生育次数无关,与月经初潮年龄成正比。结论:动脉期左侧卵巢静脉显影,对于无症状经产女性是一种常见的CT征象,可能与初潮年龄相关,但尚未发现疾病相关特异性。     

大脑大静脉畸形的影像学诊断

目的探讨大脑大静脉畸形的影像学诊断价值。资料与方法回顾性分析4例经证实为大脑大静脉畸形的CT、MRI、MRA及DSA的影像学表现。结果4例均显示有大脑大静脉瘤样扩张,瘤巢形成伴周围引流小静脉增多。其中1例表现为天幕动脉瘘入大脑大静脉并动脉瘤形成伴直窦血栓,另3例表现为中线旁区的动静脉畸形引起大脑大静脉瘤样扩张。结论多种影像学检查方法的结合应用对大脑大静脉血管畸形的准确诊断有重要价值。     

Iliac vein compression syndrome: outcome of endovascular treatment with long-term follow-up

Objective

To retrospectively evaluate technical success and long-term outcome of endovascular treatment in patients with iliofemoral deep vein thrombosis (DVT) due to iliac vein compression syndrome (IVCS).

Materials and methods

Between March 2003 and September 2006, 36 consecutive patients (26 women [72%], 10 men, mean age 50 ± 18 years) with acute or chronic iliofemoral deep vein thrombosis due to iliac vein compression syndrome were evaluated for outcome of endovascular treatment. Stent patency was estimated by using the Kaplan–Meier method.

Results

Technical success was achieved in 34 of 36 patients (94%). Six patients with acute or subacute thrombosis had chronic occlusion of the left common iliac vein. Rethrombosis of the stents was observed in four patients. Primary and secondary patency rates were 85 and 94% at 1 year, and 80 and 82% at 4 years. Resolution of symptoms was achieved in 17 of 20 patients (85%) with acute and subacute DVT, and 4 of 16 patients (25%) with chronic DVT. Major complication was seen in one patient (3%).

Conclusion

Intimal changes in the left common iliac vein are mostly chronic in nature even in patients with acute DVT secondary to IVCS. Endovascular treatment with stent placement has a high technical success rate and good long-term patency in the treatment of acute and chronic DVT due to IVCS. Symptomatic improvement seems to be better in patients with acute than chronic DVT due to IVCS.     

Pre- and postprandial alterations of portal venous flow: evaluation with single breath-hold three-dimensional half-Fourier fast spin-echo MR imaging and a selective inversion recovery tagging pulse

PURPOSE: To evaluate the influence of food intake on portal flow using unenhanced magnetic resonance imaging (MRI). MATERIALS AND METHODS: The study population included 29 healthy subjects. A selective inversion recovery tagging pulse was used on the superior mesenteric vein (SMV) and splenic vein (SpV) to study the correlation of tagged blood in the portal vein (PV). MRI was performed before and 60-90 min after a meal. RESULTS: The flow signal from the SMV increased in 97% of the subjects after the meal. Before the meal the portal flow was dominated by flow from the SpV in 59% of the subjects, while it was dominated by flow from the SMV in 76% of the subjects after the meal. The most common distribution pattern of the flow signal from the SpV before the meal was in the central part of the main PV (55%), while it was in the left side (45%) after the meal. The most common distribution pattern of the flow signal from the SMV was in the bilateral sides of the main PV both before and after the meal (62%). CONCLUSION: This technique shows potential for evaluating pre- and postprandial alterations of flow from the SpV and SMV in the PV under physiological conditions.     

Right Gastric Venous Drainage: Angiographic Analysis in 100 Patients

Objective

To evaluate the pattern of right gastric venous drainage by use of digital subtraction angiography.

Materials and Methods

A series of 100 consecutive patients who underwent right gastric arteriography during transcatheter arterial chemoembolization for hepatocellular carcinoma were included in this study. Angiographic findings were retrospectively analyzed with respect to the presence or absence of the right and aberrant gastric veins, multiplicity of draining veins, aberrant right gastric venous drainage sites, and the termination pattern of aberrant right gastric veins (ARGVs). We also compared the relative size of the right and left gastric veins.

Results

A total of 49 patients collectively had 66 ARGVs. The common drainage sites for the ARGVs included the hepatic segment IV (n = 35) and segment I (n = 15). The termination pattern of ARGV could be classified into 4 different types. The most common type was termination as a superficial parenchymal blush formation in small areas without demonstrable portal branches. A statistically significant difference was found for the dominancy of the right gastric vein in gastric venous drainage between the two groups with or without ARGV (p < 0.05, Fisher''s exact test). In the group of patients without ARGV (n = 51), the right gastric vein was equal to (n = 9) or larger than (n = 17) the left gastric vein in 26 patients (26 of 51, 51%).

Conclusion

The incidence of ARGV is higher than expected with four distinct types in its termination pattern. The right gastric vein may play a dominant role in gastric venous drainage.     

经皮血管内激光消融治疗下肢静脉曲张的初步结果观察

目的 :探讨经皮血管内激光消融 (PELA)治疗下肢静脉曲张的初步效果和安全性。方法 :对 16例 2 2条下肢静脉曲张的患者行PELA ,所有患者均有明显的浅静脉曲张 ,同时伴活动后下肢酸胀、疼痛和乏力 ,8例伴肿胀或色素沉着。主要设备为英国DIOMED半导体激光治疗仪。结果 :2 2条患肢经PELA处理即刻静脉造影见大隐静脉主干均闭塞 ,血流中断。 16例患者随访 3～ 12个月 ,原肉眼可见的曲张浅静脉均消失 ,患者不再伴有活动后酸胀、疼痛、乏力或水肿等表现。所有病例无并发症发生。结论 :PELA治疗下肢静脉曲张简单、安全 ,初步结果令人满意。     

Venous variants and anomalies on routine abdominal multi-detector row CT

OBJECTIVE: This study aims to determine the types and prevalence rates of anatomic variations of the hepatic veins, portal vein, inferior vena cava and renal veins, and to establish statistical correlations between various anomalies and frequency differences between male and female using multi-detector row computed tomography (CT). MATERIALS AND METHODS: One thousand one hundred and twenty patients (588 men, 532 women) were evaluated with routine abdominal CT. Frequencies of different variants were noted and compared, and correlations between three categories of variation were tested. RESULTS: In total, 1261 abdominal vein variants and anomalies were identified in 756 (67.5%) of 1120 patients. Six hundred and forty-two hepatic vein variants were detected in 468 (41.8%) patients. One or more inferior right hepatic veins were identified in 356 (31.8%) individuals, and tributary hepatic veins were detected in 147 (13.1%) patients. Portal vein variations and anomalies were observed in 307 (27.4%) cases. The most frequent of these was trifurcation (139 patients, 12.4%). A total of 311 inferior vena cava and renal vein variants were identified in 258 (23%) cases. Six patients (0.5%) exhibited inferior vena cava anomalies, 62 (5.5%) had circumaortic renal veins, 53 (4.7%) had retroaortic renal veins, and 210 (18.8%) had multiple renal veins. CONCLUSION: The prevalence of abdominal vein variations is high, and routine abdominal CT demonstrates these abnormalities very well. The data suggest that hepatic vein variants and multiple right renal veins are more frequent in women than in men, and that hepatic vein variation is correlated with portal vein variation.     

经皮穿脾门静脉插管技术及其在肝癌介入治疗中的应用

目的 探讨经皮穿脾门静脉插管的可行性、操作技术及其在肝癌介入治疗中的应用价值。材料与方法 选用微创穿刺器械,对23例需行门静脉插管介入治疗而不适合采用经皮穿肝或手术置管等方法的肝癌患者,在X线导引下采用经皮穿脾的方法行门静脉插管。结果 20例（86.96％）患者经皮穿脾门静脉插管获得成功,3例（13.04％）失败（均因脾静脉穿刺失败）。1例（4.35％）患者术后出现急笥腹痛伴腹腔内出血,其余患者无严重并发症。结论 采用经皮穿脾途径行门静脉插管是一种可供选择的门静脉插管方法。     

肥胖与非肥胖患者大隐静脉剥脱术后中期效果比较

目的探讨肥胖与非肥胖患者行大隐静脉剥脱术后中期效果的差异。方法选择2012年7月至2013年12月,在承德医学院附属医院因下肢浅静脉曲张并接受大隐静脉剥脱术的患者为研究对象。随机抽取30例肥胖患者(体质量指数≥28 kg/m~2)为肥胖组,以年龄、性别、静脉临床症状严重程度评分(VCSS)及股静脉反流情况为参照,以1∶1匹配非肥胖患者作为非肥胖组。比较两组患者中期随访结果。结果两组患者平均随访13.1个月。肥胖组患者持续穿戴弹力袜的时间短于非肥胖组(P<0.05)。随访中,所有患者VCSS及Aberdeen静脉曲线问卷(AVVQ)评分均较术前有明显改善,但肥胖组AVVQ评分高于非肥胖组(P<0.05);而VCSS评分,两组间比较,差异无统计学意义(P>0.05)。术后股静脉反流的改变情况,两组间比较,差异也无统计学意义(P>0.05)。结论下肢静脉曲张合并肥胖患者行大隐静脉剥脱术后至中期阶段,相应体征及生活质量均能得到明显改善,但患者主观症状的改善程度劣于非肥胖患者,这可能与前者术后穿戴弹力袜的时间相对较短有关。而在股静脉反流的改变方面,肥胖可能并非重要影响因素。