影像学评价对选择Budd-Chiari综合征介入治疗途径的价值

目的 探讨BCS介入术前彩色多普勒超声、CT、磁共振、血管造影等影像学检查对设计介入治疗途径的价值。方法 根据彩色多普勒超声、CT、磁共振、血管造影等影像学检查结果，依据下腔静脉与肝静脉、副肝静脉的关系．采用不同的介入手术方法及入路，经股静脉、经颈静脉、经皮经肝穿刺或经副肝静脉开通下腔静脉、肝静脉、副肝静脉或同时开通。结果 根据术前影像学检查，决定手术方案、选择合理的术式和入路。50例手术均获得成功，疗效确切。其中下腔静脉狭窄34例（膜性20例，节段性14例），肝静脉狭窄、闭塞10例，下腔静脉狭窄伴肝静脉阻塞3例，肝静脉闭塞伴副肝静脉狭窄、闭塞2例。49例下腔或，和肝静脉开通后球囊扩张，共置入金属支架29例。肝小静脉闭塞1例，行TIPS术。术后随访1～36月，其中2例下腔静脉膜性狭窄球囊扩张术后分别于6和8个月出现再狭窄，后行金属支架置入．症状消失。1例因肾功能衰竭死亡。结论 通过术前检查．正确选择手术方式，可避免手术盲目性，避免再次手术，减少手术并发症，节约手术费用，获得良好的手术效果。     

超声在肝窦阻塞综合征中的诊断价值

目的探讨肝窦阻塞综合征超声声像图特征及评估超声在肝窦阻塞综合征中的诊断价值。方法回顾性分析8例由我院临床诊断肝窦阻塞综合征(HSOS)的患者超声声像图,观察肝脏大小形态及内部回声特点、肝静脉、门静脉、肠系膜上静脉及下腔静脉内径及血流情况、脾脏大小、胆囊壁厚度及腹腔积液量。结果 8例患者的超声表现为肝脏体积增大,回声减低,分布不均匀。8例肝静脉内径变细,4例流速减低。6例出现门静脉增宽,5例血流速度减低。2例出现门静脉及肠系膜上静脉血栓。2例患者出现脾脏体积增大。8例患者伴有腹腔积液。8例出现胆囊壁水肿增厚。4例患者下腔静脉肝后段变细。结论彩色多普勒超声对肝窦阻塞综合征有很重要的诊断及鉴别诊断价值。     

大静脉受累的白塞病七例造影表现及介入治疗

目的 探讨白塞病(BD)累及大静脉的影像表现与介入治疗。方法 确诊为BD37例患者，7例经血管造影证实有大静脉受累，其中上腔静脉阻塞综合征2例，下腔静脉阻塞综合征3例，2例同时合并上下腔静脉阻塞综合征。7例患者先行溶栓、活血治疗，并对5例有下腔静脉阻塞患者．在狭窄及阻塞区行扩张成形或植入支架。结果 血管造影显示阻塞始于右锁骨下静脉者2例，左右锁骨下静脉均阻塞及上腔静脉-头臂静脉阻塞者各1例，同时合并下腔静脉阻塞综合征，下腔静脉狭窄阻塞及血栓形成3例，其中1例合并肝静脉闭塞。经治疗全部患者症状改善，部分患者血流复通。结论 BD引起的大静脉阻塞是一种少见的损害，主要表现为上下腔静脉系统的狭窄、阻塞及继发血栓形成，经溶栓、激素治疗，结合血管成形及内支架置入，可获得满意的临床疗效。     

彩色多普勒超声对布加综合征的诊断价值

对24例布加综合征（BCS）患者行彩色多普勒超声检查，观察其二维超声表现及血流特征，判断肝内外血管病变及侧支血管、血流动力学改变情况。结果示下腔静脉阻塞19例，肝静脉阻塞3例，两者同时阻塞2例，与数字血管减影造影（DSA）符合率为91．7％（22／24）。认为彩色多普勒超声对判断BCS的血管阻塞部位、程度、范围及侧支循环情况准确率高，可为临床制定治疗方案和预后评估提供依据。     

下肢动脉狭窄闭塞性疾病诊断过程中彩色多普勒超声的应用

目的分析下肢动脉狭窄闭塞性疾病诊断过程中彩色多普勒超声的应用价值及体会。方法回顾性分析我院2013年10月~2015年10月收治的经数字减影血管造影(DSA)检查确诊为下肢动脉狭窄闭塞性疾病患者62例的临床资料,对其进行彩色多普勒超声检查,与造影检查结果进行对比,分析彩色多普勒超声检查的敏感度、特异性、阳性预测值及诊断符合率等。结果彩色多普勒超声检查出轻度狭窄99节段,中度狭窄61节段,重度狭窄31节段,闭塞129节段,符合率分别为90%、84.72%、73.81%、89.58%;与DSA相比,彩色多普勒超声诊断下肢动脉狭窄闭塞性疾病的敏感度为89.1%,特异度为95.5%,诊断正确率为93.2%。结论下肢动脉狭窄闭塞性疾病诊断采用彩色多普勒超声检查具有简便、无创、经济、可重复、快速安全的优势,且诊断准确率较高,故具有较高的临床应用价值。     

经颈静脉肝内门体分流术及肝静脉成形术治疗肝静脉型Budd-Chiari综合征的临床意义

目的分析经颈静脉肝内门体分流术(TIPS)及经皮肝或经颈静脉途径肝静脉成形术等介入手段治疗肝静脉型Budd-Chiari综合征(BCS)的临床意义。方法回顾性分析2000年5月至2012年10月收治的32例肝静脉型BCS的临床资料。其中男15例,女17例;平均年龄(38±6)岁;肝功能Child-Pugh评分(9.6±2.2)分;肝静脉近段闭塞8例,肝静脉闭塞合并下腔静脉狭窄4例,全肝静脉闭塞11例,肝小静脉闭塞9例;急性3例,亚急性或慢性29例。患者主要临床表现为顽固性腹水和食管静脉曲张破裂出血,采用彩色多普勒超声、CT血管造影或MRI血管造影、上消化道钡餐及内镜检查明确诊断。治疗方法包括:TIPS 9例,改良TIPS 11例,单独经皮肝或经颈静脉途径肝静脉成形术8例,经皮肝肝静脉成形术联合下腔静脉成形术4例。结果所有患者均成功完成介入或手术治疗,其中TIPS或改良TIPS术后,患者出血控制,腹水逐渐消退,肝功能明显好转;门静脉压力由(42±8)cm H2O(1 cm H2O=0.098 kPa)下降至(27±5)cm H2O(t=20.20,P=0.001),门静脉血流速度由(18±6)cm/s增加至(52±10)cm/s(t=15.02,P=0.001)。住院期间因肝功能不全死亡1例,肝门分流道急性阻塞1例。术后随访3~241个月,平均随访(102±26)个月,分流道狭窄性扩张内支撑2例,肝静脉狭窄再扩张2例。结论经皮肝或经颈静脉途径肝静脉成形术与TIPS均是治疗肝静脉型BCS的有效方法,可根据患者病情酌情选择治疗方法。     

布加氏综合征患者下腔静脉病变的超声诊断误诊分析

目的本文主要是为了分析布加氏综合征(BCS)患者下腔静脉(IVC)病变运用超声诊断出现误诊的原因。方法选择2014年2月~2015年1月来我院接受诊断的布加氏综合征下腔静脉病变患者100例的超声图像和IVC造影结果进行分析和比较。结果 BCS患者100例中IVC病变出现误诊的患者23例,误诊率为23%,其中下腔静脉节段性和膜性闭塞误诊为狭窄的16例、节段性及膜性狭窄误诊为闭塞的3例、外压性假性狭窄误诊为真心狭窄的5例。结论受BCS患者血流动力学特征因素以及IVC解剖特点的影响,超声对于BCS患者的IVC病变诊断容易出现误诊,ICV病变远段管腔扩张实际程度并不是该种病变狭窄程度的一个可靠指征。     

Budd-Chiari综合征命名的建议--肝静脉血栓形成还是下腔静脉肝段的血栓形成

Budd-Chiari Syndrome(BCS)的定义最初为有症状的肝静脉血栓形成.越来越多的报告认为,该综合征也累及下腔静脉(IVC)肝段闭塞,因而再次定名为肝静脉流出道梗阻,包括下腔静脉的闭塞病变.IVC肝段病变的病理解剖并不一致,可以为腔静脉狭窄,或近乎完全闭塞,或可为中央有孔的膜,膜或薄或厚,或有一长段闭塞,因此产生多种名称,如下腔静脉膜状闭塞(membranous obstruction of IVC,MOVC)、狭窄.许多学者推论这一综合征是先天性血管发育不良,但并不清楚肝静脉血栓形成(经典BCS)和IVC闭塞性病变是同一疾病抑或为两个综合征,MOVC和IVC狭窄与肝静脉血栓形成是否无关.随影像技术的发展已有证据表明MOVC及IVC狭窄是肝静脉血栓形成的后遗症.流行病学研究进一步发现原发性IVC闭塞症和BCS不同,临床上这两种病也有区别.本文试图修订这些概念并建议它们是两种不同的综合征.     

门静脉-右心房分流术治疗(Budd-Chiari)综合征

本文报告3例Budd chiari综合征。其中,2例肝静脉主干闭塞合并肝后腔静脉狭窄和下腔静脉压升高;1例肝静脉主干和下腔静脉广泛阻塞。3例均行门静脉-右心房分流术。开放出流后门静脉压下降。下肢静脉压不降低。随访5～14个月。因肝静脉闭塞引起的腹水、腹壁浅静脉扩张和肝、脾肿大消失或明显减轻。2例分别于术后2和7个月行血管造影,证实人工血管通畅。手术后,随着时间的延长,门静脉、人工血管和     

MSCT和MRI在布加综合征诊疗中的应用

目的:探讨多排螺旋CT(multislice spiral computed tomography,MSCT)及核磁共振成像(magnetic resonance imaging,MRI)在布加综合征(Budd-Chiari syndrome,BCS)诊疗中的应用价值.方法:回顾性分析53例经数字减影血管造影(digital subtraction angiography,DSA)或介入手术证实BCS患者的MSCT、MRI和手术资料.男35例,女18例;原发型49例,继发型4例;将BCS分为3型:下腔静脉型、肝静脉型和混合型.分析其直接征象、侧支血管、尾叶改变、强化特点、门脉高压征象以及合并疾病等,与DSA结果比较.结果:MSCT和MRI对BCS的诊断正确率分别为82.9%、93.8%,差异无统计学意义(?2=1.489,P0.05).49例准确显示B C S病变部位、阻塞性质、阻塞长度及走形方向、与周围组织的关系;准确显示肝内、肝外侧枝血管及其空间位置关系.下腔静脉(inferior vena cava,IVC)膜性阻塞17例,有孔型9例,无孔型8例;IVC节段性闭塞7例(≤2.5 cm),长段闭塞8例(2.5 cm).14例清晰显示"危险"侧支血管,清晰显示需成形的肝静脉(hepatic vein,HV)7例,副肝静脉3例.8例MRI准确显示IVC和/或HV内血栓的位置、血栓分期,12例MSCT发现IVC和/或HV内血栓;18例MSCT显示IVC内钙化.全部手术成功,3 m o后复查,治疗血管血流通畅、支架位置佳.结论:MSCT和MRI为BCS的诊断和介入治疗提供丰富、全面的信息,具有重要的应用价值.     

Budd-Chiari syndrome： Diagnosis with three-dimensional contrast-enhanced magnetic resonance angiography

AIM: To evaluate the role of three-dimensional contrast-enhanced magnetic resonance angiography (3D CE MRA) in the diagnosis of Budd-Chiari syndrome (BCS). METHODS: Twenty-three patients with BCS underwent 3D CE MRA examination, in which 13 cases were secondary to either hepatocellular carcinoma (11 cases), right adrenalcarcinoma (1 case) or thrombophlebitis (1 case) and 10 suffered from primary BCS. The patency of the inferior vena cava (IVC), hepatic and portal veins as well as the presence of intra- and extrahepatic collaterals, liver parenchymal abnormalities and porto-systemic varices were evaluated. Inferior vena cavography was performed in 10 cases. The diagnosis of IVC obstruction by 3D CE MRA was compared with that demonstrated by inferior vena cavography.RESULTS: The major features of BCS could be clearly displayed on 3D CE MRA. Positive hepatic venous signs included tumor thrombosis (9 cases), tumor compression (2 cases), nonvisualization (4 cases) and focal stenosis (2 cases). Positive IVC findings were noted as severe stenosis or occlusion (10 cases), tumor invasion (2 cases), thrombosis (3 cases), thrombophlebitis (1 case) and septum formation (3 cases). Intrahepatic collaterals were shown in 9 patients,2 of them with “spider web“ sign. The displayed extrahepatic collaterals included dilated azygos and hemi-azygos veins (13 cases) and left renal-inferior phrenic-pericardiophrenic veins (2 cases). The occlusion of the left intrahepatic portal veins was found in 2 cases. Porto-systemic varices were detected in 10 patients. Liver parenchymal abnormalities displayed by 3D CE MRA were enlargement of the caudate lobe (7 cases), heterogenous enhancement (18 cases) and complicated tumors (13 cases). Compared with the inferior vena cavography performed in 10 cases, the accuracy of 3D CE MRA was 100 % in the diagnosis of IVC obstruction.CONCLUSION: 3D CE MRA can display the major features of BCS and provide an accurate diagnosis.     

彩色多普勒超声对主-肺动脉间隔缺损的诊断价值

目的　探讨彩色多普勒超声 ( CDFI)对主 -肺动脉间隔缺损的 ( APSD)诊断价值。方法　应用彩色多普勒超声的二维图像 ,多普勒频谱和彩色显像对 3例主 -肺动脉间隔缺损的解剖及血流动力学异常进行观察。结果　行 CD-FI检查 3例患者 ,诊断为 APSD,其中 型 2例 , 型 1例 ,合并室间隔缺损 1例 ,均经手术证实。APSD彩色多普勒超声特征是 :主 -肺动脉内异常高速血流由升主动脉射入 ,主 -肺动脉扩张 ,左、右肺动脉增宽 ,左心增大。结论　CD-FI可用作诊断 APSD的首选方法 ,具有无创、安全、准确及可重复应用等优点     

Surgical treatment of Budd-Chiari syndrome:analysis of 221 cases

BACKGROUND:Budd-Chiari syndrome (B-CS) refers to post-hepatic portal hypertension and/or inferior vena cava hypertension caused by obstruction of blood flow at the portal cardinal hepatic vein.The treatments of B-CS include operations on pathological membrane lesions,shunting and combined operations.Studies have shown that China,Japan,India and South Africa have a high incidence of B-CS.In China,the Yellow River Basin in Henan,Shandong,Jiangsu and Anhui Provinces also have a high incidence,around 10 per 100...     

Endemicity and clinical picture of liver disease due to obstruction of the hepatic portion of the inferior vena cava in Nepal

Obstructive lesion of the hepatic portion of the inferior vena cava is common in Nepal. The clinical data on 150 patients who were seen at the Liver Unit, Bir Hospital, Kathmandu, in three years from 1990 to 1992 were analysed. Although the majority of patients were over 20 years of age, 25 patients were below 10 years of age; there were more males than females in this study. This disease accounted for 17% of 866 patients with chronic liver disease and for nearly one quarter of 267 biopsies performed on this patient group during the same period. Obstructive lesions of the inferior vena cava seem to be more common among poor people with malnutrition. Clinically, our patient group could be divided into acute (n= 27), subacute (n= 43) and chronic (n= 80) cases. The important clinical features are hepatomegaly and/or ascites and, in chronic cases, prominent dilated superficial veins over the body trunk with cephalad flow. Ultrasound is the most helpful diagnostic procedure, especially in subacute and chronic cases, as it frequently demonstrates caval obstruction, thrombosis, dilated hepatic veins and intrahepatic collaterals. Diagnosis is confirmed by cavography, which shows a caval obstruction of varying lengths at the cavo-atrial junction or a marked narrowing of the hepatic portion of the vena cava. In subacute and chronic cases cavography also demonstrates collateral veins, such as the ascending lumbar, hemiazygos and azygos that drain into the superior vena cava. Chronic cases had periods of exacerbation often associated with bacterial infection. The aetiology of inferior vena cava obstruction at its hepatic portion is not known, but there seems to be a frequent association of bacterial infection with the disease.     

超微血流成像技术在颈部淋巴结结核分型诊断中的应用价值

目的 对比超微血流成像(superb micro-vascular imaging,SMI)技术应用前后结核性淋巴结血流显示与超声分型诊断的差异,探讨SMI在颈部淋巴结结核诊断中的临床应用价值。方法 回顾性分析2018年3—6月就诊于上海市肺科医院超声科行淋巴结穿刺活检且明确诊断为颈部淋巴结结核的30例患者,对30例患者的78枚肿大淋巴结,对比应用灰阶超声+彩色多普勒血流成像(color doppler flow imaging, CDFI)与灰阶超声+SMI的血流信号显示情况和超声分型诊断的差异,并与病理结果进行比较。结果 应用CDFI血流模式,78枚淋巴结15枚出现内部血流信号,14枚出现外周血流信号,未出现混合血流信号,血流显示率为37.2%(29/78);应用SMI血流模式,19枚出现内部血流信号,22枚出现外周血流信号,6枚出现混合血流信号,血流显示率为60.3%(47/78),差异有统计学意义(χ²=16.056,P=0.000)。灰阶超声+CDFI分型结果为:Ⅰ型16枚(20.5%),Ⅱ型22枚(28.2%),Ⅲ型19枚(24.4%),Ⅳ型21枚(26.9%);灰阶超声+SMI肿大淋巴结分型结果为:Ⅰ型22枚(28.2%),Ⅱ型14枚(17.9%),Ⅲ型21枚(26.9%),Ⅳ型21枚(26.9%),两者差异有统计学意义(χ²=8.000,P=0.018)。78枚肿大淋巴结病理检查结果为:以淋巴细胞、肉芽肿性病变为主25枚(对应超声Ⅰ型),以凝固性坏死组织为主13枚(对应超声Ⅱ型),以坏死组织及肉芽肿性病变为主20枚(对应超声Ⅲ型),以纤维组织增生为主20枚(对应超声Ⅳ型)。灰阶超声+SMI分型结果与病理结果间具有极好的一致性(Kappa=0.948),符合率达96.2%(75/78)。灰阶超声+CDFI分型结果与病理结果对比,也有很好的一致性(Kappa=0.830),符合率为87.2%(68/78)。结论 SMI应用后能显著提高颈部结核性淋巴结血流的显示率,更准确地进行淋巴结结核分型诊断,指导临床医生及时选择有效治疗方案,具有更高的临床应用价值。     

Diagnostic value of combined transhepatic venography and inferior vena cavography in chronic Budd-Chiari syndrome

In a series of 19 patients with Budd-Chiari syndrome, transhepatic venography and inferior vena cavography were used to localize the site of hepatic outflow obstruction. Classification into two types was made on the basis of the site of obstruction. Four cases were grouped as type I, in which obstruction was localized in the hepatic vein alone, and the inferior vena cava (IVC) was patent. Fifteen cases were of type II, in which there was a well-defined obstruction in the intrahepatic portion of the IVC or ostium of a hepatic vein. This study highlights the frequent occurrence of IVC obstruction as a cause of chronic Budd-Chiari syndrome in northern India and the utility of transhepatic venography in its diagnosis.     

超声造影在经颈静脉肝内门体支架分流术后支架管通畅性监测中的应用价值

目的评价超声造影(CEUS)在监测肝硬化患者经颈静脉肝内门体支架分流术(TIPS)后支架管通畅情况中的应用价值。方法回顾性分析2012年1—10月四川大学华西医院211例TIPS术后肝硬化患者的超声检查资料,其中40例行CEUS检查,14例行增强CT检查。以增强CT检查及临床随访结果作为金标准,分别计算彩色多普勒血流成像(CDFI)及CEUS诊断TIPS术后支架管闭塞的敏感度、特异度、阳性预测值及阴性预测值。结果二维超声显示所有支架管均位于门静脉与下腔静脉之间;CDFI显示171例患者支架管内血流充盈良好,38例支架管内未见血流信号,2例支架管血流充盈缺损。CEUS显示21例支架管通畅,17例支架管闭塞,2例支架管附壁血栓。17例CEUS诊断为支架管闭塞的患者中3例失访,14例行增强CT检查,均显示支架管闭塞。CDFI诊断TIPS术后支架管闭塞的敏感度、特异度、阳性预测者及阴性预测者分别为100%、89%、40%和100%;CEUS诊断TIPS术后支架管闭塞的敏感度、特异度、阳性预测者及阴性预测者均为100%。结论超声检查作为监测肝硬化患者TIPS术后支架管是否通畅的常规检查手段,CEUS能更加准确的显示支架管闭塞,尤其是CDFI显示支架管血流困难时采用CEUS可明确支架管的通畅情况。     

Percutaneous balloon angioplasty of membranous obstruction of the inferior vena cava

BACKGROUND: Membranous obstruction of the inferior vena cava is common in African and Asian countries. METHODS AND RESULTS: Between January 1999 and January 2002, 19 patients were prospectively studied. The mean age of the patients was 38+/-6.9 years. All of them had swelling of the abdomen and ankle edema. Five patients (26.3%) had jaundice, 9 (47.3%) had hepatomegaly, and 5 (26.3%) splenomegaly. Ultrasonography could detect the site of obstruction in 18 patients (94.7%). Vena cavography demonstrated obstruction of the inferior vena cava at the level of the diaphragm, with 2 patients (10.5%) having additional intrahepatic obstruction. The mean pressure gradient was 22+/-3.5 mmHg. Seventeen patients underwent balloon angioplasty using a Joseph balloon. The procedure was successful in 15 patients (88.2%). The post-angioplasty mean pressure gradient was 5+/-1.4 mmHg. On follow-up, 3 patients (20%) developed features of restenosis: out of them, 2 underwent successful redilatation. CONCLUSIONS: Balloon angioplasty of membranous obstruction of the inferior vena cava is feasible with a high success rate, without any rupture of the inferior vena cava.     

Membranous obstruction of the inferior vena cava and hepatocellular carcinoma in South Africa

This study was undertaken to establish the frequency of membranous obstruction of the inferior vena cava in South Africa, to characterize the pathology of the lesion and to define its relationship to hepatocellular carcinoma. Over a 9-yr period 101 cases of membranous obstruction of the inferior vena cava into the right atrium was occluded in all cases in which it was examined, and two basic patterns of the abnormality in the hepatic portion of the inferior vena cava have been described. The histologic picture in the liver was a chronic congestive fibrosis. In 44 cases of congestive fibrosis, diagnosed from liver biopsy specimens from black patients over a 5-yr period, vena caval membranes were demonstrated on cavography in 38 (86.4%). Hepatocellular carcinoma developed in 48 of the 101 cases (47.5%), indicating the importance of this defect in the pathogenesis of hepatocellular carcinoma in South Africa.     

Pseudo-Budd-Chiari syndrome: extrinsic deformity of the intrahepatic inferior vena cava mimicking membranous obstruction

Budd-Chiari syndrome secondary to membranous obstruction of the intrahepatic inferior vena cava is a treatable form of chronic liver disease. I report a patient with portal hypertension in whom distortion of the inferior vena cava by cirrhosis and increased intraabdominal pressure initially suggested this condition. The correct diagnosis was made by obtaining lateral views during inferior vena cavography, which demonstrated a tapered, rather than membranous, obstruction, along with normal hepatic venous anatomy and pressure and markedly increased portal vein pressure during transhepatic puncture with a thin needle. That extrinsic deformity of the inferior vena cava may mimic membranous obstruction has not been emphasized recently. This distinction is important as surgical membranotomy is not indicated in patients with cirrhosis and secondary deformity of the inferior vena cava.