肝血管瘤在脂肪肝中的声学探讨

目的探讨肝血管瘤在脂肪肝中的声学变化。方法追踪观察58例肝血管瘤在脂肪肝中的彩色多普勒超声表现。结果脂肪肝中肝血管瘤的彩色多普勒超声检出率为78％,未发现肝血管瘤结节为22％。结论肝血管瘤彩色多普勒超声检查可作为本病诊断的首选方法,但肝血管瘤结节在脂肪肝中的显像有一定的局限性。     

彩色多普勒诊断表浅部位血管瘤的价值(附11例报告分析)

血管瘤是起源于血管的内皮细胞和周围组织的良性肿瘤,其彩色多普勒表现的报道并不多见,本文报告11例经手术证实,探讨其彩色多普勒超声诊断特征及临床应用价值。     

彩色多普勒超声诊断累及肝脏的遗传性、出血性毛细血管扩张症

目的探讨遗传性、出血性毛细血管扩张症患者累及肝脏时的彩色多普勒超声表现.方法用二维及彩色多普勒超声观察6例经临床明确诊断的遗传性、出血性毛细血管扩张症患者的肝脏及肝内外血管的走行及分布.结果 6例患者均表现为肝固有动脉纡曲扩张伴血流速度增快,5例同时伴有肝内动脉纡曲扩张;2例发现肝内动脉-静脉瘘,3例发现肝内动脉-门脉瘘;2例合并有肝硬化,其中1例同时合并有血管瘤.结论肝内外动脉纡曲扩张伴血流速度增快为累及肝脏的遗传性、出血性毛细血管扩张症的主要超声特点,彩色多普勒超声在此病的筛查、诊断及追踪观察等方面具有重要作用.     

肝血管瘤的彩色多普勒超声分析

目的：探讨肝血管瘤的血流表现和特征；血流检出率的影响因素及措施，提高对肝血管瘤的诊断和鉴别诊断水平。方法：用彩色多普勒超声观察血流多少、分布、性质和血流动力学参数。结果：1．血流检出率25％，其中动脉性血流9．4％，静脉性血流15．3％；2．大多数为少血供型，占93％；绝大部分呈低速动脉性血流。结论：彩色多普勒超声对肝血管瘤的诊断与鉴别诊断有很高价值。     

彩色多普勒超声对蔓状血管瘤的诊断

目的：探讨彩色多普勒超声在诊断蔓状血管瘤中的应用价值。方法：对16例蔓状血管瘤患者进行二维及彩色多普勒超声检查，同时部分肿物进行三维重建及拓宽视野成像。结果：本组16例经彩色多普勒超声诊断蔓状血管瘤后经手术病理及血管造影进一步证实。蔓状血管瘤声像图主要表现为：瘤体内部呈近似不均质无回声，无回声内可见不规则走行迂曲呈管状或呈条索状弱回声或高回声。CDFI血流丰富，呈五彩镶嵌状。三维成像及拓宽视野成像技术可以很好的反映出瘤体的立体形态、范围及与周围组织的关系。结论：彩色多普勒超声对蔓状血管瘤的诊断及治疗方式的选择有重要的应用价值。三维超声及拓宽视野成像技术是二维超声的很好补充。     

试述彩色多普勒在肝血管瘤和肝癌鉴别的诊断价值

目的探讨彩色多普勒在肝血管瘤和肝癌鉴别的诊断价值。方法 2006年1月至2010年12月间本院超声检查病例中抽取23例肝血管瘤和23例肝癌初次彩色多普勒检查诊断进行回顾对比分析。结果 23例肝血管瘤灰阶声像图表现15例为高回声、6例为低回声、2例为混合性回声;23例肝癌灰阶声像图表现18例为低回声、3例为高回声、2例为等回声;23例肝血管瘤的彩色多普勒检查均显示血流不丰富,其中在5例较大的海绵状血管瘤中可检查出少量低速血流,均为静脉型血流。23例肝癌的彩色多普勒检查有21例彩色多普勒均显示丰富动脉型或同时有静脉型血流信号,均呈高速高阻型;有2例小于2cm的高回声小肝癌因未显示血流而误诊为肝小血管瘤,其余经手术及其他临床检查证实均符合彩色多普勒初次诊断。结论肝血管瘤和肝癌在治疗上及预后是完全不同的,而部分的肝血管瘤和肝癌在灰阶声像图上较难区别,而彩色多普勒则可以通过肿瘤的血管多普勒超声特征性改变作鉴别,因其快速、安全、无创伤性、方便、准确性高、病人易于接受而作为首选的检查方法。     

低回声型肝血管瘤的彩色多普勒超声检测

目的　探讨彩色多普勒超声在诊断低回声型血管瘤中的应用价值。方法　应用二维超声、彩色多普勒血流图 (CDFI)、彩色能量多普勒血流图 (PDI) ,结合脉冲多普勒频谱对 18例共 2 2个低回声型肝血管瘤进行研究。结果　 CDFI对低回声型肝血管瘤内血流显示率 2 7.2 7% ,PDI对低回声型肝血管瘤血流显示率 90 .91%。动脉血流检出率为 2 2 .73%。“病灶染色” 9个 (40 .91% )。低回声型肝血管瘤血流呈低速 ,阻力指数 (RI) <0 .6(6 0 % )。结论　彩色多普勒超声对低回声型肝血管瘤的诊断和鉴别诊断有重要价值。     

肝血管瘤的彩色多普勒诊断及其病理组织对照

肝血管瘤的彩色多普勒诊断及其病理组织对照同济医科大学附属同济医院（４３００３０）超声诊断室黄道中，张青萍，乐桂蓉随着Ｂ型超声诊断技术的普及和提高，肝海绵状血管瘤的发现率日益增多［１、２］，鉴别肝脏良恶性肿瘤已成为重要的课题。本文报道用彩色多普勒诊断肝...     

二维超声及彩色多普勒血流显像对肝血管瘤的对比观察

目的探讨彩色多普勒血流显像在肝血管瘤的诊断中的价值.方法对54例肝血管瘤进行二维及彩色多普勒血流显像检查,并记录其各自特点.结果 31例直径小于3厘米的血管瘤只有2例周边见点状零星血流信号,而直径大于3厘米的血管瘤却有15例周边及内部见条状血流信号.结论在肝血管瘤的诊断中,二维超声的作用是主要的,彩色多普勒血流只对直径大于3厘米的瘤体的诊断有补充和深入的作用.     

彩超在早期肝癌鉴别诊断中的应用价值分析

目的:探讨彩超在早期肝癌鉴别诊断中的应用价值。方法:选取2013年11月—2016年11月平顶山中医院收治的经B超检查诊断为肝脏占位性病变患者83例,所有研究对象均接受彩色多普勒超声检查,以病理组织活检及经皮肝穿刺活检等方式检查结果作金标准,评估彩色多普勒超声鉴别诊断早期肝癌的准确度,并分析不同肝脏占位性病变彩色多普勒超声影像学表现。结果:经病理组织活检及经皮肝穿刺活检等方式检查证实,本组83例肝脏占位性病变患者中原发性肝癌42例,转移性肝癌21例,肝腺瘤3例,肝血管瘤17例。经彩色多普勒超声诊断发现原发性肝癌37例,诊断准确度为88.10%(37/42);转移性肝癌18例,诊断准确度为85.71%(18/21);肝腺瘤2例,诊断准确度为66.67%(2/3);肝血管瘤13例,诊断准确度为76.47%(13/17)。结论:采用彩色多普勒超声对早期肝癌进行诊断具有较高准确度,可有效鉴别肿瘤良恶性质及疾病类型,可为临床干预方案的及早制定提供可靠依据,具有推广价值。     

慢性肝炎高压氧治疗前后肝血流及超微结构变化和疗效观察

目的：研究高压氧治疗慢性瘀胆型肝炎患者肝血流及肝脏病理超微结构的变化和疗效。方法：采用肝血流图仪及多普勒Ｂ超测肝血流图收缩波、门静脉右支的血流量与生化,免疫组化及治疗前后病理电镜检查数据为观察指标。结果：高压氧治疗后,７６％的患者肝血流图收缩波升高,７０％患者门静脉右支血流量增加,前后比较Ｐ＜０．０５。肝功能ＡＬＴ、ＢＩＬＩ好转率分别为８８．９％,９３．３％。线粒体肿胀、肝细胞及毛细胆管瘀胆明显减轻,Ｋｕｐｆｅｒ细胞减少,治疗前后比较Ｐ＜０．０５。结论：高压氧可明显增加门静脉、肝动脉血流量,改善肝功能,减轻肝内瘀胆和炎症     

Nature of Doppler perfusion index changes in patients with colorectal cancer liver metastases.

OBJECTIVE: Occult hepatic metastases from colorectal cancer result in an increase of the ratio of arterial hepatic blood flow to total hepatic blood flow, described as the Doppler perfusion index. Whether this alteration is due to an increase in arterial blood flow or a decrease in portal venous inflow has not yet been unequivocally determined. The purpose of this study was to analyze changes in hepatic perfusion in patients with liver metastases from colorectal cancer by standardization of hemodynamic parameters to body surface area. METHODS: Hemodynamic parameters (crosssectional area, blood flow, and congestive index) were measured for the common hepatic artery and portal vein with duplex color Doppler sonography in 20 patients with liver metastases and 20 healthy control subjects and evaluated relative to body surface area. RESULTS: No statistically significant differences in age, body surface area, cross-sectional area of the common hepatic artery, and congestion index of the common hepatic artery and portal vein were observed between control subjects and patients with liver metastases. Patients with liver metastases had significantly greater arterial hepatic blood flow and Doppler perfusion index and significantly smaller portal cross-sectional area portal blood flow as well as total liver blood flow (P <.001). CONCLUSIONS: This study supports the theory that the primary mechanism of alteration in liver perfusion is the reduction of portal inflow with subsequently increased arterial hepatic blood flow.     

内皮素和一氧化氮在烧伤后肝脏血流调节中的作用

目的：研究内皮素（ＥＴ）和一氧化氮（ＮＯ）在烧伤后肝脏血流调节中的作用。方法：动态观察大鼠３０％Ⅲ度烧伤后血浆及肝脏ＥＴ、ＮＯ含量及肝脏血流量的变化,应用ＥＴ受体拮抗剂和外源性ＮＯ载体观察其对烧伤大鼠肝脏血流量的影响。结果：大鼠烧伤后肝脏血流量明显下降,伤后血浆及肝组织ＥＴ和ＮＯ含量明显升高,由于ＥＴ升高幅度相对较大,ＥＴ／ＮＯ比值也显著增加,肝组织ＥＴ、ＥＴ／ＮＯ改变与肝脏血流量的降低呈显著负相关;伤后在一定的液体复苏下应用两种ＥＴ受体拮抗剂和ＮＯ供体在一定程度上明显使肝血流量增加,同时拮抗ＥＴ受体Ａ（ＥＴＡ）、ＥＴ受体Ｂ（ＥＴＢ）较单独拮抗ＥＴＡ效果好,ＥＴ受体拮抗剂和ＮＯ供体配合使用效果更佳。结论：烧伤后由于肝脏ＥＴ的增加和内源性ＮＯ相对不足,导致肝脏血管收缩造成肝脏血流量下降,拮抗ＥＴ的作用和（或）补充外源性ＮＯ则可一定程度逆转烧伤后肝脏血流量下降     

Is it feasible to monitor total hepatic blood flow by use of transesophageal echography? An experimental study in pigs

OBJECTIVES: Total hepatic venous blood flow is determined by the common hepatic arterial blood flow and the venous outflow from stomach, spleen, pancreas, small intestine, and bowel, collected by the portal vein, and thus represents overall splanchnic perfusion. We investigated whether transesophageal echography (TEE) can provide a method for bedside assessment of hepatic venous blood flow useful as a noninvasive method for measuring splanchnic perfusion in clinical practice. DESIGN AND SETTING: Experimental study in 15 anesthetized and ventilated pigs in an animal research laboratory. INTERVENTIONS: TEE-derived calculations of hepatic venous blood flow were compared with liver blood flow measurements using perivascular ultrasound flow probes surgically positioned on portal vein and common hepatic artery. Parameters were determined at baseline and after modulating splanchnic perfusion by either PEEP maneuver (15 cmH2O) or intravenous epinephrine (0.1 microgram kg-1 min-1). MEASUREMENTS AND RESULTS: Diameter (d) and velocity time integral (VTI) of all three hepatic veins were determined by TEE, heart rate (HR) was derived from electrocardiography and flow subsequently calculated as Q = pi.(d/2)(2).0.57.VTI.HR. Regression analysis of matched TEE and flow probe values showed a significant linear relationship (r2 = 0.698). Bias analysis revealed a systematic underestimation of liver blood flow by TEE, possibly due to use of 0.57 as correction factor for mean velocity, while changes in liver blood flow were reliably detected. CONCLUSION: TEE offers a noninvasive approach for monitoring hepatic perfusion and may be used in patients.     

应用彩色多普勒结合D-山梨醇肝清除率测定对肝硬化血流动力学的研究

目的：探讨肝硬化血流动力学的变化。评估肝脏储备功能。方法：应用彩色多普勒检测结合D－山梨醇肝清除率测定对12例肝硬化和8例正常人进行了肝总血流量、肝功能性血流量及频谱的检测。结果：肝硬化组肝清除率相对于肝总血流量明显减少，肝功能性血流量明显降低，肝静脉频谱振幅减低，肝储备功能下降。结论：彩色多普勒检测结合D山梨醇肝清除率测定能够客观准确的评价肝储备功能。     

肝静脉流速曲线波型与肝纤维化关系的实验研究

目的 探讨肝静脉流速曲线波型与肝纤维化间的关系。方法 20只健康家兔以浓度为1．2g／L的硫代乙酰胺溶液作为唯一饮用水的方法建立肝纤维化动物模型，分别在建立模型前、建立模型中第8周、第12周、第16周时对所有实验动物进行肝静脉流速曲线波型检测，并与肝组织穿刺活检结果相比较。结果 随着建立模型时间的延长，肝静脉流速曲线波型发生异常改变的实验兔数目增多，第16周时与正常时比较，差异有非常显著性意义。结论 肝静脉流速曲线波型的改变在一定的程度上反映了肝实质病变情况。     

肝血管瘤彩色及频谱多普勒的特征性回顾分析

目的探讨肝血管瘤患者彩色及频谱多普勒的特征以及危险因素,为诊断提供指导信息。方法回顾性分析80例肝血管瘤患者肿瘤内血管分型,肝脏固有动脉血流速度及管腔直径,肝血管瘤中肝静脉血流波形,同时lo-gistic分析肝血管瘤发生的危险因素。结果在80例患者中,72.5%（58/80）为肿瘤斑块内血管型,肝脏固有动脉血流速度平均为Vmax=55±4.23,RI=0.54±5.13;肝血管瘤中肝静脉血流波形均为HV0,瘤体内外静脉血流Dv/Sv=0.53±0.132,Sv〈60 mm/s。体重指数大于28、有遗传史以及患有抑郁症为肝血管瘤发生的危险因素。结论彩色多普勒评价肿瘤内血管分型,以及检测动静脉血流速度,管腔直径和瘤体内外静脉波形有利于肝血管瘤诊断,并且认为体重指数大于28、有遗传史以及患有抑郁症为肝血管瘤发生的独立危险因素。     

Doppler ultrasonographic evaluation of hepatic blood flow in clinical sepsis

The aim of this study was to determine the hemodynamic response of the liver to sepsis by measuring hepatic blood flow. Thirty patients with sepsis were examined using Doppler ultrasonography and measurements of portal venous blood flow, hepatic arterial blood flow and total hepatic blood flow were recorded. Data were retrospectively reviewed and compared with findings for a control group of 12 healthy subjects. Significantly increased values of hepatic blood flow (p<0.01) and portal venous blood flow (p<0.001) were observed in patients during early sepsis (5 h). In contrast, hepatic arterial blood flow was not significantly different from controls. During late sepsis (24 h), no significant differences were observed between patients and healthy controls. Our results support the concept that hepatic blood flow is significantly increased in patients with early sepsis due to increased portal venous blood flow; however, during late sepsis, hepatic blood flow is similar to that in controls.     

彩色多普勒血流显象在肝占位性病变中的应用

我们运用彩色多普勒血流显象检查了109例肝占位性病变。原发性肝癌的肿瘤内动脉血流、从肿瘤外周进入病灶内的动脉血流的检出率分别为90.91％(40/44)、50.00％(22/44)。尽管其它肝占位性病变(如转移癌、血管瘤)也可出现上述血流,但是,其检出率明显低于原发性肝癌(P<0.01),具有鉴别诊断意义。彩色多普勒超声检查具有无创性、操作简单、血流检出率高等特点,它可为原发性肝癌二维图象诊断提供更为丰富的血流信息,从而,进一步提高了超声诊断的特异性。     

Influence of route of hepatic administration on drug availability

The work investigates functional variability of hepatic arterial and portal venous streams in relation to drug availability. In an isolated rat liver system perfused in all experiments at a constant total flow of 10 ml X min-1, drug availability was found to be 18 and 3 times greater for lidocaine and meperidine, respectively, when infused through the hepatic artery compared to portal vein administration. When both hepatic artery and portal vein were perfused, drug availability increased log linearly for lidocaine, and linearly for meperidine with increasing hepatic artery flow contribution. Injection of 15-micron gamma-labeled microspheres into the hepatic artery and portal vein did not reveal arteriovenous or portovenous shunting channels greater than 15 micron in diameter. However, the ratios of the mean transit times of albumin and red blood cells were found to be significantly lower through the hepatic artery, indicating a possible reduction in perisinusoidal albumin space. When both hepatic artery and portal vein were perfused, linear correlations were obtained for values of this ratio plotted against increasing hepatic artery flow contributions. Data from the red blood cell transit time studies, as well as data on lidocaine availability, suggest the presence of functionally separate capillary beds for the hepatic arterial and venous streams.