门静脉转流下入肝血流阻断动物模型的建立及评价

目的：设计一种可避免门静脉淤血的动物模型,排除门静脉淤血对肝脏功能恢复的影响,从而为肝脏耐受缺血时限的实验研究提供理想的实验模型。方法：利用大鼠肝脏解剖特点,分别阻断肝左、中、右叶肝蒂（ 约占全肝９５ ％ ） ,造成受累肝叶完全缺血;保留尾叶血供作为肝蒂阻断期间门静脉血经肝脏回流入下腔的通道,到预定观察终点,去除肝蒂阻断夹即恢复肝脏血流,切除尾状叶。经血管造影及染料示踪法观察肝蒂阻断后门静脉流出道的完整性及肝脏缺血的完全性以及肝蒂阻断前后血液动力学变化;并观察了肝脏再灌流后２４ ｈ 的病理变化及动物７ ｄ 存活率,与单纯入肝血流阻断组做对照。结果：这种新设计的门静脉转流下入肝血流阻断动物模型,肝脏缺血可靠,门静脉流出道完整,阻断肝蒂前后血液动力学稳定;肝脏病理变化及动物术后７ ｄ 存活率转流组与单纯入肝血流阻断组有明显差异,前者好于后者。结论：该模型复制方法简单、重复性高、对机体附加创伤和生理干扰小,是研究大鼠对入肝血流阻断耐受时限的理想模型。     

门静脉转流下入肝血流阻断动模型的建立及评价

目的：设计一种可避免门静脉淤血的动物模型,排除门静脉淤血对肝脏功能恢复的影响,从而为肝脏耐受缺血时限的实验研究提供理想的实验模型。方法：利用大鼠肝脏解剖特点,分别阻断肝左、中、右叶肝蒂（约占全肝９５％）。造成受累肝叶完全缺血;保留尾叶血供作为肝蒂期间门静脉血经肝脏回流入下腔的通道,到预定观察终点,去除肝蒂组断夹即恢复肝脏血流,切除尾状叶。经血管造影及染料示踪法观察肝蒂阻断后门静脉流出道的完整性及肝     

肝动脉栓塞与经肝静脉逆行栓塞联合应用的实验研究

目的：为了使肿瘤及载瘤肝段完全坏死，获得介入性肝段（叶）切除的效果，作者进行了肝动脉栓塞与经肝静脉逆行栓塞（ＴＨＡＥ－ＲＨＶＥ）联合应用的动物实验。材料和方法：８只健康犬进行了ＴＨＡＥ－ＲＨＶＥ，肝动脉栓塞时用带囊导管阻断区域肝静脉后，向相应区域肝动脉注入碘化油，再注入明胶海绵碎片；逆行栓塞肝静脉时，在球囊阻断肝静脉下注入无水酒精－泛影葡胺（１１）混合剂。对照组（单纯肝静脉逆行注入酒精）４只。术后复查肝功能、ＣＴ，定期处死实验动物，行肝脏及肺病理学检查。结果：ＴＨＡＥ－ＲＨＶＥ及对照组技术均成功，实验组与对照组肝功能指标均呈一过性增高。ＣＴ复查显示实验组碘油充填栓塞区肝段及所属门脉分支。实验组术后１周病理检查，栓塞区肝段呈完全性、凝固性坏死，肝静脉、门静脉分支壁厚，其内充满机化血栓，２周时坏死周围有肉芽组织及炎症细胞浸润，４～８周栓塞肝叶明显萎缩，坏死区逐步为纤维组织取代。对照组肝段呈不完全性凝固性坏死，范围较小。结论：ＴＨＡＥ－ＲＨＶＥ方法安全，能获得选择性肝叶（段）切除的效果，可用于单发性巨块型肝癌的治疗。     

正常肝脏磁共振灌注加权成像初步研究

目的:研究正常肝脏不同分叶PWI成像情况.方法:选择14例正常肝脏行PWI扫描,根据时间-信号曲线获取肝脏各分叶灌注峰值及灌注峰值时间,计算脾灌注峰值前后的最大斜率,动脉期和静脉期灌注参数值.把所得的数据按照不同肝叶分组,进行统计学分析.结果:肝脏左、右叶的血流灌注量差异有显著性意义.结论:肝动脉在肝左叶的血流比例大于肝右叶,门静脉在肝右叶的血流比例大于肝左叶.     

能谱CT成像对肝硬化不同肝叶血流动力学的对比研究

目的 探讨能谱CT成像基物质分离技术在肝硬化患者不同肝叶血流动力学改变中的临床应用.方法 收集本院30例临床确诊为肝硬化的患者,行上腹部能谱CT增强扫描,扫描后重建单能量图像及基物质分离图像,在碘-水配对基物质图像上分别测量动脉期(AP)、门静脉期(VP)肝脏5叶(尾状叶、左外叶、左内叶、右前叶、右后叶)碘浓度(IC)及同层面腹主动脉碘浓度(ICaorta),分别计算出肝脏各叶动脉期碘分数(AIF)、门静脉期碘含量(PVIC)、动脉期及门静脉期标准化碘浓度(NIC),比较不同肝叶动脉期及门静脉期碘浓度(ICAP,ICVP)、AIF、PVIC、动脉期及门静脉期标准化碘浓度(NICAP,NICVP)等参数的差异.采用单因素方差分析对数据进行统计处理.结果 肝硬化患者尾状叶ICAP、ICVP,NICAP、NICVP,AIF均高于肝脏其余4叶,差异有统计学意义(P<0.05),但在肝脏其余4叶之间无明显统计学意义(P>0.05);PVIC在尾状叶稍低于其余4叶,但结果无统计学意义(P=0.929).结论 能谱CT基物质分离技术(碘基图)定量测量肝脏各叶IC可以评价肝硬化患者不同肝叶血流动力学的改变和差异,为临床提供更多的肝硬化血流改变信息.     

LAVA整合ASSET在肝血管成像中的应用价值

目的：探讨肝脏快速容积采集（LAVA）整合阵列空间敏感编码技术（ASSET）在肝血管成像中的价值。方法：对80例肝病患者行肝脏常规MRI平扫及增强扫描。增强扫描采用LAVA整合ASSET;将LAVA采集的原始图像行最大强度投影（MIP）处理并分析其对肝脏病变及肝血管关系的显示情况。结果：80例肝脏病灶全部清晰显示。其中,肝癌42例44个,显示肿瘤血管30例,肿瘤供血动脉明显增粗、变形、移位20例,门静脉受侵25例,门静脉癌栓6例;肝血管瘤5例,肝囊肿8例,轻度肝炎6例,肝硬化18例,胆总管下段乳头状瘤1例。MIP显示肝动脉3级以上分支76例（95%）、门静脉3级以上分支72（90%）及肝静脉3级以上分支64例（80%）。结论：LAVA整合ASSET在肝脏动态扫描中可在较短时间内获得多期高质量增强图像并提供血管解剖信息,具有较高临床应用价值。     

螺旋CT在TIPSS术前应用的意义

为了在经颈静脉肝内门腔静脉支架分流术（ＴＩＰＳＳ）前了解肝静脉与门静脉各分支解剖关系，对患者行螺旋ＣＴ扫描，并探讨使用三维血管重建技术获取肝静脉和门静脉分支立体空间结构图的方法。本研究回顾性分析了３０例肝硬化患者的肝脏螺旋ＣＴ平扫和增强扫描结果，试图对各方法显示肝静脉、门静脉分支的灵敏度做出评价。１　材料与方法３０例患者均经临床病史、实验室检验、Ｂ超和ＣＴ影像诊断为肝炎后肝硬化门静脉高压。男２５例，女５例。肝功能Ｃｈｉｌｄ分级Ａ级６例、Ｂ级１７例、Ｃ级７例。其中１０例有上消化道出血史，２例合并原…     

16层螺旋CT肝脏多期扫描的方法与实用价值

目的:探讨16层螺旋CT肝脏多期扫描的方法及应用价值。方法:150例疑有肝脏病变的患者行16层螺旋CT多期扫描。层厚7.5mm,螺距1.375,扫描时间0.8s/r,静脉团注对比剂80～120ml,分别延时23～28s、45～50s58～65s行肝动脉期(动脉早期)、门静脉流注期(动脉晚期)和肝静脉期(实质期)扫描,并对图像作回顾性分析,比较增强前后腹主动脉、门静脉、肝静脉的CT值变化和后处理图像显示肝动脉、门静脉、肝静脉的能力。结果:16层螺旋CT肝脏多期扫描,肝脏血管增强后与增强前的密度差在91.9HU以上,VR、MIP、MPR图像上100%显示肝动脉(150/150),门静脉显示率为96.7%(145/150),肝静脉显示率为95.3%(143/150)。5例门静脉显示不清的病例中,3例为肝癌合并肝门区淋巴结转移,1例肝癌合并门静脉癌栓形成,1例为严重肝硬化合并腹水、脾肿大;7例肝静脉显示不清中有5例与门静脉显示不清的5例为相同病例,其余2例为严重肝硬化合并腹水。结论:16层螺旋CT肝脏多期扫描对评估肝脏病变、肝脏血管的正常、变异以及病变对血管的影响有很大帮助,但是对于严重肝硬化门静脉高压、门静脉狭窄、门静脉血栓(包括癌栓)形成的病例,显示门静脉和肝静脉不理想。     

门静脉阻断兔肝VX2移植瘤的DSA评价

目的评价DSA在兔肝VX2移植瘤经门静脉阻断后显示肝动脉与门静脉的价值。方法20只新西兰大白兔随机分为移植瘤体生长3周后门静脉阻断组和移植瘤体未行门静脉阻断对照组,2周后分别行兔肝动脉与门静脉DSA检查。结果DSA在肝动脉分支的显示效果上较血管灌注好,实验组肝左外叶肿瘤组织可见少许肝动脉供血。肝左外叶门静脉分支结扎(PBL)者均能被DSA证实。结论DSA可直观地显示兔肝动脉与门静脉的空间解剖细节,在兔肝门静脉阻断效果的评价中起着重要作用。     

64层螺旋CT肝脏血管成像最佳条件的探讨

目的 探讨64层螺旋CT在肝脏动脉、门静脉和肝静脉血管成像中的最佳触发阈值及延迟时间.方法 将120例未患影响肝脏血流动力学改变的患者按触发阈值100 HU、120 HU、140 HU、160 HU、180 HU、200 HU分为6组,每组20人,分别对肝动脉行智能追踪技术(SureStart acquisition)法、门静脉及肝静脉期采用动脉扫描结束后间隔20 s、40 s时延迟成像法行上腹部的多期扫描,进行不同血管的三维重建并评价其效果.结果 经统计学分析,当触发阈值为120 HU肝动脉优良率最高(95%);当时间间隔为20 s时门静脉的优良率最高;当时间间隔为40 s肝静脉的优良率最高.结论 64层螺旋CT肝脏血管成像建议的扫描条件为肝动脉触发阈值120 HU,肝动脉成像后间隔20 s及40 s扫描,对肝动脉、门静脉及肝静脉成像可达到较高的满意度.     

Haemodynamic changes in the liver under balloon occlusion of a portal vein branch: evaluation with single-level dynamic computed tomography during hepatic arteriography

AIM: To assess haemodynamic changes in the liver under temporary occlusion of an intrahepatic portal vein. MATERIALS AND METHODS: Between February 2000 and October 2004, 16 patients with hepatobiliary disease underwent single-level dynamic computed tomography during hepatic arteriography (SLD-CTHA) under temporary balloon occlusion of an intrahepatic portal vein. All patients needed percutaneous transhepatic portography for therapy of their disease. SLD-CTHA was undertaken to clarify the time-attenuation curve influenced by portal vein occlusion, and it was performed continuously over a period of 30s. The difference in absolute attenuation of the liver parenchyma in segments with occluded and non-occluded portal vein branches was determined by means of the CT number, and the difference in absolute attenuation of the occluded and non-occluded portal veins themselves was also evaluated. RESULTS: SLD-CTHA demonstrated a demarcated hyperattenuation area in the corresponding distribution of the occluded portal vein branch. The attenuation of the liver parenchyma supplied by the occluded portal vein was significantly higher than that in the non-occluded area (p<0.01). The balloon-occluded portal branch enhancement in 15 of 16 cases (94%) appears due to arterio-portal communications. Failure to evaluate a remaining case for portal branch enhancement was due to absence of a visualized portal branch in the section. CONCLUSION: Under temporary occlusion of an intrahepatic portal vein, hepatic angiography produced enhancement of the occluded portal branches and their corresponding parenchymal distribution; this finding is considered consistent with the presence of arterio-portal communications.     

Hepatic arteriography under temporary hepatic venous occlusion]

Hepatic arteriography with and without temporary segmental hepatic vein occlusion was performed in 10 patients, five of whom had chronic liver injury. Hepatic arteriograms obtained during hepatic venous obstruction demonstrated significantly more peripheral and definite arterial branches in the occluded area and fewer peripheral branches in the non-occluded segment. A prolonged, dense hepatogram (sinusoidogram) showing hepatofugal opacification of the portal vein was obtained in the occluded area. Only one case with a large veno-venous anastomosis did not show these findings. Hepatic arteriograms in two cases with hepatocellular carcinoma provided clear visualization of peripheral portal branches that could act as efferent tumor vessels during regional temporary hepatic vein occlusion. Temporary hepatic venous occlusion may cause a sudden increase of hepatic arterial flow in the occluded area and transsinusoidal arterioportal communication there. This method can be useful for the diagnosis and arterial infusion or embolization therapy of hepatic diseases.     

Hepatic arterial flow distribution with hepatic neoplasms: significance in infusion chemotherapy

Hepatic artery radionuclide flow studies and hepatic angiography in eight patients with various hepatic neoplasms were evaluated to determine the patterns of arterial flow distribution in the presence of portal vein occlusion. Increased hepatic arterial blood flow to the lobe or segment supplied by the occluded portal vein was observed in all patients. This phenomenon must be taken into account when positioning catheters for hepatic artery infusion chemotherapy; while it may improve the flow of chemotherapeutic agents to tumors located in the area of an occluded portal vein branch, it may also result in diversion of flow to the normal hepatic parenchyma away from tumors occupying the hepatic segments with patent portal venous flow. Hepatic angiography and radionuclide flow studies provide the necessary information for correct positioning of hepatic artery infusion catheters.     

Altered hepatic hemodynamics caused by temporary occlusion of the right hepatic vein: evaluation with Doppler US in 14 patients

PURPOSE: To evaluate with Doppler ultrasonography (US) the altered hepatic hemodynamics caused by temporary occlusion of the right hepatic vein. MATERIALS AND METHODS: The study group consisted of 14 patients being considered for hepatic arterial infusion or transarterial embolization. In all patients, maximum peak velocity of the blood flow in the right portal vein was measured with Doppler US before and during the occlusion of the right hepatic vein. In 13 patients, color Doppler US was performed to evaluate Doppler signal in the portal venous branch in the occluded area before and during occlusion. Average peak velocity in the right hepatic artery in eight patients was measured by using a transducer-tipped guide wire before and during occlusion. RESULTS: Maximum peak velocity of the right portal vein significantly decreased with occlusion (P <.01). Hepatic venous occlusion changed the Doppler signal in the portal venous branch in the occluded area from hepatopetal to no signal in 10 patients; to weakened hepatopetal in two; and to hepatofugal in one. Average peak velocity of the right hepatic artery showed a decrease or plateau for 15-30 seconds after the start of occlusion and then a rapid increase to reach a plateau at around 75-90 seconds, with 1.5-2 times as much velocity as that before occlusion. CONCLUSION: Increase in hepatic arterial velocity is accompanied by a decrease in the portal velocity with temporary occlusion of the right hepatic vein; the expected increased drainage through the portal vein was almost undetectable.     

Budd-Chiari综合征:肝静脉病变的多排螺旋CT诊断

目的探讨多排螺旋CT(MSCT)对Budd-Chiari综合征(BCS)肝静脉阻塞病变的诊断价值。方法对比分析26例BCS的肝静脉血管造影和术前1周内的MSCT平扫与增强扫描表现。结果26例MSCT横断面图像和重建图像显示肝静脉共计70条,其中56条肝静脉闭塞,包括13条肝右静脉闭塞,21条肝中静脉闭塞,22条肝左静脉闭塞;另显示21条副肝静脉代偿性增粗;其中1例肝右静脉伴有血栓形成。与下腔静脉或经皮肝穿刺肝静脉造影相比,肝静脉的符合率为92.11%。结论MSCT能准确显示BCS肝静脉的血流动力学变化、阻塞部位,性质以及肝内交通支情况,诊断价值高,能可靠的指导制订治疗方案。     

肝纤维化与门静脉、肝实质螺旋CT峰值之间的相关性

目的 评价CT同层动态增强扫描在分析肝纤维化中的作用.方法 建立家兔肝纤维化模型21只,分批分期行CT同层动态增强扫描,后取肝脏行病理检查,然后进行分组,用SPSS 10.0统计软件分析.结果 发现门静脉与肝实质增强峰值在正常对照组与肝纤维化各组间有统计学意义(P＜0.05),而肝纤维化各组间无统计学意义.另外,门静脉与肝实质增强峰值时间无统计学意义.结论 门静脉与肝实质增强峰值有可能对评价肝纤维化有一定价值.     

Predictors of Occlusion of Hepatic Blood Vessels after Irreversible Electroporation of Liver Tumors

PurposeTo examine predictors of midterm occlusion in portal and hepatic veins within or adjacent to the ablation zone after irreversible electroporation (IRE) of liver tumors.Materials and MethodsThis retrospective cohort analysis included 39 patients who underwent CT-guided IRE of liver tumors. Vessels within or adjacent to the ablation zone were identified on CT images acquired immediately after the procedure, and the positional relationships with the ablation zone (within/adjacent), locations (proximal/distal), and diameters (< 4 mm or ≥ 4 mm) were evaluated. Using contrast-enhanced follow-up scans, each vessel was classified as patent, stenosed, or occluded. Associations between vessel occlusion and each variable were investigated.ResultsOverall, 33 portal veins and 64 hepatic veins were analyzed. Follow-up scans showed occlusion in 12/33 (36.7%) portal veins and 17/64 (26.6%) hepatic veins. Vessels within the ablation zone were occluded significantly more frequently than vessels adjacent to the ablation zone (portal: 55.6% [10/18] vs 13.3% [2/15], P = .04; hepatic: 45.4% [15/33] vs 6.4% [2/31], P = .011). Vessels with a diameter < 4 mm were also occluded significantly more frequently than vessels with a diameter ≥ 4 mm (portal: 72.7% [8/11] vs 18.1% [4/22], P = .011; hepatic: 54.8% [17/31] vs 0% [0/33], P < .001). The respective positive and negative predictive values for occlusion of vessels categorized as both within and < 4 mm were 88% (7/8) and 82% (20/25) for portal veins and 79% (15/19) and 96% (43/45) for hepatic veins.ConclusionsMidterm vessel occlusion after liver IRE could be predicted with relatively high accuracy by assessing ablation location and vessel diameter.     

Prevention of hepatic infarction as acute-phase complication of TIPS by temporary balloon occlusion in a patient with primary myelofibrosis

Severe acute liver dysfunction occurred following transjugular intrahepatic portosystemic shunt (TIPS) creation in a patient with massive ascites due to portal hypertension associated with primary myelofibrosis. On US and TIPS venography, we considered that the acute liver ischemia was induced by TIPS. To avoid diffuse hepatic infarction and irreversible liver damage, a balloon catheter was inserted transjugularly into the TIPS tract and occluded it to increase portal venous flow toward the peripheral liver parenchyma. The laboratory data indicating hepatic dysfunction were improved after the procedure. We should pay attention to the possible occurrence of acute hepatic ischemia and infarction after TIPS creation even in a case of noncirrhotic portal hypertension. In such cases, temporary balloon occlusion of TIPS is an effective therapeutic method, probably as a result of inducing the development of arterial compensation through the peribiliary plexus.     

经皮经肝肝静脉成形术治疗肝静脉阻塞型Budd-Chiari综合征

目的探讨和评价经皮肝穿刺入路肝静脉腔内成形(percutaneous transhepatic recanalization and angioplasty of hepatic vein,PTRAHV)治疗肝静脉型Budd-Chiari综合征(BCS)的可行性和中远期疗效。方法自1996年9月至2006年10月收治单纯肝静脉阻塞型及肝静脉阻塞伴有下腔静脉阻塞型BCS患者101例,在PTRAHV前后经导管测定患者肝静脉压力,观察围手术期并发症,并分别于术前、术后6个月彩超测量门静脉内径、平均流速和血流方向等,计算对比血流量,随访观察受干预血管的通畅率。结果技术成功率91.1%(92/101)。术中急性肝静脉血栓形成3例,术后发生肝穿刺道出血2例,肝包膜下血肿1例,肺栓塞1例,均经保守治疗痊愈,未发生致死性并发症。随访74例,术后6个月门静脉平均流速和血流量参数均高于术前(P<0.05);术后6个月、1年和2年的受干预血管的初始再通率分别为83.8%(62/74)、78.4%(58/74)和76.5%(39/51),其辅助再通率分别为94.6%(70/74)、91.9%(68/74)和84.3%(43/51)。结论采用PTRAHV技术治疗膜性或节段性肝静脉型BCS操作简单、安全、有效,其中远期效果令人满意。     

第二肝门重建术──一种治疗布卡氏综合征的新技术

评价一种新的介入方法，即穿刺肝段下腔静脉瑟肝内静脉之间的肝实擀并置入金属支撑架重建第二肝门来治疗缺少第二肝门的布卡氏综合征。材料和方法：２．例ＢＣＳ病人经皮穿刺肝内静脉证实无第二肝门结构，分别采用经右侧颈静脉和经皮经肝穿刺途径，在肝段下腔静脉与肝内静脉之间经肝实擀重建第二肝门，支撑架直径为１０ｍｍ，术后半年复查肝静脉造影，并随访半年以上。