布-加综合征和肝内型门静脉高压症患者血流动力学比较

目的:探讨布-加综合征(Budd-Chiarisyndrome,B-CS)及肝内型门静脉高压症(portalhypertension,PHT)患者血流动力学变化之间的差异。方法:利用彩色多普勒超声对40例B-CS患者、24例PHT患者和24名正常人的门静脉(PV)内径和平均血流速度、每min血流量(Q)进行测算,同时观察肝静脉(HV)、下腔静脉(IVC)变化和肝内侧支血管的形成情况等。以24例健康者为正常对照。结果:B-CS组及PHT组PV内径均大于正常对照组(P均<0.05),PV平均血流速度和Q均小于正常对照组(P均<0.05)。B-CS组上述3指标均小于PHT组(P均<0.05)。B-CS组患者HV病变38例(95%),表现为开口闭塞或狭窄,远端扩张、迂曲等;PHT组发现HV轻度受压狭窄10例(41.7%),HV显示不清3例(12.5%);正常对照组HV均显示正常。IVC病变24例(60%),主要表现为IVC膜性阻塞、狭窄、闭塞,阻塞下方有血栓和IVC扩张,IVC壁搏动消失,血流速度加快、呈双向和逆流等;PHT组发现IVC轻度狭窄8例(33.3%),余正常;正常对照组IVC显示正常。B-CS组特征性的肝内侧支血管形成,表现为HV之间的交通支开放,副肝静脉扩张等;PHT组和正常对照组未发现肝内侧支。结论:B-CS涉及多支HV、PV和IVC系统,患者存在复杂的血流动力学变化。肝内侧支出现是B-CS区别于PHT的特征性表现。

Comparative study on hemodynamics of Budd-Chiari syndrome and intrahepatic portal hypertension

Aim: To explore the differences of hemodynamics between B-CS and intrahepatic portal hypertension(PHT). Methods: Color Doppler was used to measure the diameter,flow volume, and mean flow speed of portal vein(PV)of 40 B-CS patients, 24 PHT patients, and 24 normal controls. The changes of hepatic veins(HV)and inferior vena cava and the forming of intrahepatic bypass were observed. Results: The diameters of PV in both B-CS and PHT group were wider than those in control(P<0.05), while the mean flow speed and flow volume in both groups were lower than those in control(P<0.05), and those parameters in B-CS group were lower than those in PHT group(P<0.05). There were 38 patients(95%) with HV lesion in B-CS group, and the main performances were narrowness or obstruction of the outlet, terminal dilation and/or circuity; 24 patients(60%) with PV lesion in PHT group, and the main performances were membranous occlusion, narrowness, segmental obstruction, thrombosis under the membrane, IVC dilation, and the beating of IVC wall vanished, speeding flow, double-direction or reversed flow in IVC. The forming of intrahepatic bypass was specially presented in B-CS group, and the main performances were the forming of bypass between HVs and accessory HV dilation. Conclusion: The lesions of B-CS include HVs, PV and IVC systems, and the patients with B-CS have complicated hemodynamic changes. Intrahepatic bypass is a special performance for B-CS to differ from PHT.