B超诊断葡萄胎

目的 分析葡萄胎的超声影像特点,提高诊断符合率.方法 对本院近7年来超声诊断的50例葡萄胎进行回顾性分析.结果 本组50例经病理证实,诊断符合率94%;2例误诊,占6%.结论 典型葡萄胎的二维超声图像具有特异性,有较高的临床符合率,但是非典型葡萄胎需结合临床、实验室检查及随访,才能作出正确诊断,减少误诊.     

B超介导经皮肝门静脉穿刺溶栓治疗肝硬化脾切术后门静脉血栓形成

目的探索B超介导门静脉穿刺溶栓治疗肝硬化脾切术后门静脉血栓形成(PVT)的安全性和有效性.方法肝硬化脾功能亢进实施脾切术后PVT患者6例,年龄35～51岁,男性4例,女性2例.B超引导下经皮经肝穿刺Seldinger方法门静脉置入4F多侧孔导管,穿越血栓,灌注尿激酶,剂量20～40万U/次,同时结合全身抗凝祛聚疗法,留置导管必要时进行再次溶栓治疗,术后继续给予抗凝祛聚疗法及B超监测.结果4例患者经1次溶栓治疗、2例患者经2次溶栓治疗成功.B超监测3例患者门静脉完全再通,3例患者门静脉2/3再通.临床症状缓解,腹水消退,均无出血、胆瘘、异位栓塞等并发症.术后随访6个月无血栓再发.结论B超介导经皮肝门静脉穿刺导管灌注溶栓药物进行溶栓治疗PVT安全、有效,早期发现早期治疗是改善预后的关键.     

肝硬化合并门静脉血栓形成的危险因素分析

目的 探讨肝硬化并发门静脉血栓形成的危险因素。方法 选取我院2013年1月~2018年1月确诊的肝硬化患者69例,其中经腹部CT或腹部超声诊断为门静脉血栓患者24例设为血栓组,未发生血栓患者45例设为对照组。回顾性分析肝硬化门静脉血栓患者与肝硬化非血栓患者的年龄、性别、肝硬化病因;比较两组患者的D-二聚体、白细胞计数（WBC）、血红蛋白（Hb）、血小板（PLT）、肌酐（Cr）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fib）、血清总胆红素（TBIL）、直接胆红素（DBIL）、白蛋白（ALB）、丙氨酸氨基转移酶（ALT）、天门冬氨基转移酶（AST）、γ-谷氨酰转肽酶（GGT）、血氨浓度、门静脉内径宽度（MVP）、脾脏厚度、脾切除史、有无合并食管胃底静脉曲张出血及腹腔积液。结果 两组性别、年龄、肝硬化病因、腹腔积液并发症比较,差异无统计学意义（P＞0．05）,两组食管静脉曲张破裂出血并发症比较,差异有统计学意义（P＜0．05）。血栓组腹部超声或螺旋CT增强扫描显示:门静脉主干血栓22例（91.67%）（1例合并肠系膜上静脉血栓,6例合并左/右门静脉分支,1例合并左/右门静脉分支及肠系膜上静脉血栓）,单纯位于左/右门静脉分支2例（8.33%）;两组患者中D-二聚体、AST、ALT、ALB、PTA、PLT差异存在统计学意义（P＜0.05）;Logistic回归模型分析显示,D-二聚体、门静脉内径宽度、Hb是肝硬化门静脉血栓形成的独立危险因素（P＜0.05）。结论 肝硬化患者应加强对患者D-二聚体、血红蛋白、门静脉内径宽度的监测,有助于患者疾病早期诊断和治疗。     

肝硬化肝门静脉血流超声测定与肝纤维化指标的比较

目的：探讨肝门静脉血流和肝纤维化指标对诊断肝硬化的诊断价值。方法：50例肝硬化患者和20例正常对照组用肝门静脉超声和放免法分别测定肝门静脉血流和肝纤维化指标。结果：肝硬化肝门静脉血流动力学指标均高于正常对照组（P〈0．05），并随着肝功能Child Puph分级程度严重而下降；活动性肝纤维化指标明显高于静止性肝硬化（P〈0．05～0．01）；超声与血清判断肝硬化的符合率比较大致相同。结论：肝门静脉超声和肝纤维化指标能判断肝硬化损害的程度。     

脾静脉的解剖与临床

目的：为保留脾的动脉吻合术提供解剖学依据。方法：按层次解剖法对25县尸检的脾静脉及其周围结构包括肝静脉长度,以及脾静脉与第Ⅰ腰椎、腹腔动脉、胰腺、右肾静脉的吡邻关系等进行观测。结果：脾静脉长度为11.8±1.75cm,中段宽径为1.22±0.14cm,脾静脉与左肾静脉大多平行,间距为2.67±0.59cm。结论：脾静脉的门静脉端管径大（1.34±0.2cm）,有一定弹性,与左肾静脉根部相距近,行脾肾静脉吻合张力不大,有利于施行脾肾静脉吻合术。     

二维超声在胎儿畸形诊断中的应用价值

本文回顾性总结了二维超声诊断胎儿畸形128例,均经引产和产后证实,符合率为100%,漏诊5例,漏诊率为3.9%,并对各类畸形进行了总结、分析,强调了二维超声在胎儿畸形诊断中的应用价值.     

二维超声在子宫发育异常诊断中的应用评价（附33例临床分析）

目的探讨二维超声对子宫发育异常的诊断价值，为正确诊断子宫发育异常提供参考。方法采用PHIL-IPS-M2540A超声诊断仪，腹部探头频率为3．5MHz，阴道探头频率为5—7．5MHz，根据所使用的探头决定膀胱的充盈情况，常规多切面、多角度扫查子宫，观察子宫的外形、子宫内膜的形态与走向及其附件情况，分析子宫发育异常的二维超声声像图特征。结果本组33例中，经超声确诊者30例，超声诊断符合率91％，误诊3例，误诊率9％。结论二维超声可作为诊断子宫发育异常的首选方法。     

三维超声成像在诊断胎儿唇腭裂上的应用

目的探讨三维超声成像在诊断胎儿唇腭裂上的应用价值。方法对门诊常规及系统产科超声检查发现的74例胎儿唇腭裂畸形进行回顾性分析。结果单纯唇裂16例,约占21.6%,唇裂伴腭裂58例,约占78.4%,其中左侧28例,右侧12例,双侧13例,正中5例。71例三维获得较满意直观的图像,三维显示率为95.9%。结论三维超声能更清晰、直观、准确地显示胎儿唇腭裂的直接征象,是二维超声必要的补充。     

门脉血流动力学变化对门脉高压出血危险的影响

目的研究病毒性肝炎患者不同阶段脾静脉、门静脉血流量及其比值(Qsv/Qpv)对门脉高压出血危险的影响。方法采用彩色多普勒超声对168例病毒性肝炎患者(慢性肝炎43例、肝硬化代偿期67例与失代偿期58例)和59例正常人门静脉、脾静脉内径、流速,再计算出相关的血流量,并进行了比较分析。结果随着病情发展,各组Qsv/Qpv不断升高,各组之间比较有非常显著性差异(P<0.01)。门静脉内径≥(1.56±0.22)cm,脾静脉内径≥(1.26±0.16)cm,脾静脉和门静脉血流量比值≥0.816±0.157时,可作为有出血危险的参数。结论采用彩色多普勒超声测量门静脉系统及其血流动力学指标,对预测食道胃底静脉曲张破裂出血及治疗和预后有重要意义。     

门静脉的解剖与变异

目的：利用经动脉性门静脉造影CT重建门静脉、肝静脉三维结构，观察生理状态下的门静脉的解剖与变异。方法：150例病人，导管置入于肠系膜上动脉内，注入造影剂后门静脉期和肝静脉期连续扫描肝脏。三维重建门静脉及肝静脉，分析门静脉的解剖与变异。结果：150次成像中门静脉变异25例，12例（8．0％）显示门静脉呈三分叉状，10例（6，7％）门静脉先分出右后支，然后上行分为左支和右前支，1例（0．7％）门静脉左支水平段缺如，门静脉右支缺如2例（1．3％），余下125例（83．3％）显示正常左右门静脉分支。结论：门静脉的三维图像重建及类型分析对术前手术方式的确定有一定的临床意义。     

门静脉部分缩窄制作SD大鼠门静脉海绵样变性动物模型

目的采用门静脉部分缩窄法建立SD大鼠门静脉海绵样变性(CTPV)的动物模型,观察成模过程中门静脉压力、门静脉及周围组织的结构变化,为临床及基础研究提供可靠、稳定的模型动物。方法将SD大鼠100只,随机分为2组:假手术组和模型组,每组各50只。模型组用21G口径的钝头针对大鼠门静脉部分缩窄术;假手术组仅对门静脉进行游离探查,不进行缩窄。各组分别在术后1、2、3、4、6w随机取出10只,行门静脉测压、门静脉造影、病理学等观察门静脉及其周围组织侧支循环的形成情况。结果假手术组大鼠术后各时间段均未形成门脉高压,门静脉造影未见有侧支循环形成。模型组术后1w即形成门静脉高压,门静脉造影显示术后第3w,肝门区可见向肝性侧支循环,术后6w,门静脉区形成典型的海绵样变性。结论用21G钝针头行门静脉部分缩窄,可以复制出类似CTPV的大鼠模型。术后3w门静脉压力达到高峰,以后稍有下降并逐渐趋于稳定,在术后3w门静脉已出现向肝性侧支循环,到6w时形成典型的门静脉海绵样变性改变。     

Congenital absence of the portal vein—Case report and a review of literature

Congenital absence of the portal vein (CAPV) is a rare anomaly in which the intestinal and the splenic venous drainage bypass the liver and drain into systemic veins through various venous shunts. To our knowledge, we have reviewed all 83 cases of CAPV, since first described in 1793. This equates to a rate of almost 2.5 cases per year over the last 30 years. Morgan and Superina (1994, J. Pediatr. Surg. 29:1239–1241) proposed the following classification of portosystemic anomalies; either the liver is not perfused with portal blood because of a complete shunt (Type I) or the liver is perfused with portal blood due to the presence of a partial shunt (Type II). In our case, abdominal venous blood drained into the suprarenal inferior vena cava via the left renal vein and dilated left gastric veins. After analyzing all reported cases, we recognize that more than 65% of patients are females and more than 30% of all published cases had been diagnosed by the age of 5 years. Additional anomalies are common in CAPV. In the reported cases, more then 22% of patients had congenital heart disease. Other commonly found anomalies include abnormalities of the spleen, urinary and male genital tract, brain as well as skeletal anomalies. Hepatic changes such as focal nodular hyperplasia, hepatocellular carcinoma, and hepatoblastoma are diagnosed in more then 40% of patients. This article also illustrates the radiological findings of CAPV. Radiological evaluation by ultrasound, CT, and MRI is helpful to detect coexisting abnormalities. Clin. Anat. 23:750–758, 2010. © 2010 Wiley‐Liss, Inc.     

探讨SPECT肝细胞显像评价肝硬化程度

目的 评价肝硬化患者的肝细胞功能及肝硬化程度。方法 对25例肝硬化患者及13例正常对照组,进行肝胆动态显像,通过三室模型获得肝细胞摄取、排泄功能的放射性－时间曲线,计算肝细胞摄取和排泄等功能指标。结果 肝硬化组高峰时间、平均残存时间均显著高于正常对照组,均P＜0．001。肝硬化组与正常组比较高峰值摄取指数、摄取斜率、排泄斜率均显著降低,均P＜0．01。结论 肝细胞显像是一种灵敏评价肝细胞代谢功能的无创性方法,可用于分析肝硬化程度。     

选择性贲门周围血管离断术的临床应用探讨

目的探讨选择性贲门周围血管离断术的临床应用效果。方法回顾性分析我院2010年1月至2013年8月86例肝硬化门脉高压接受断流手术患者的临床资料,按手术方式将其分为选择性断流组和传统断流组,对比2组的手术情况、术后肝功能指标、术后并发症情况。结果选择性断流组手术时间延长,FFP术后降低明显(P0.05),出血量和输血例数2组间无统计学差异(P0.05);选择性断流组术后ALT和AST峰值、并发症发生率均低于传统断流组(P0.05);选择性断流组平均术后住院时间较传统断流组缩短(P0.05)。结论选择性断流术能够更有效降低门静脉压力、减少术后近期并发症,值得临床推广。     

Recovery from hepatic necrosis following acute portal vein embolism with special reference to reconstruction of occluded vessels.

We examined the morphological and haemodynamic changes in the livers of rats following acute obstruction of portal vein branches by the injection of agar into the portal vein. Histological and angiographic examinations of the liver were performed after measurements of portal vein pressure in vivo and portal vascular resistance by an isolated liver perfusion method. Portal vein embolism induced hepatic necrosis in the centrilobular and midzonal areas, which was rapidly resorbed and replaced by regenerated liver cells leaving no trace. This recovery from hepatic necrosis was closely related to recanalization of obstructed portal vein branches, which led to falls in both the elevated portal vein pressure and the increased portal vascular resistance following embolization.     

肝门静脉肝内分支的形态观测及临床意义

目的 测量肝门静脉入肝后的左干、右干的有关数据，为临床肝脏疾病导管介入治疗等应用提供形态学资料。方法 取无肝病死亡后的人体肝脏标本，用游标卡尺和三角尺等进行有关数据的测量。结果 肝门静脉左干横部的长度为23～33mm；横部的根部外径为6．2～10．8mm；左干矢状部外径为6．5～9．9mm；左干外上叶支外径为3．3．6．5mm。肝门静脉右支主干长度为15～25．8mm；根部的外径为8．4～12．0mm；右后叶支外径为5．0～9．4mm；右前叶支外径为4．6～9．2mm。结论 有关形态学测量数据在肝脏疾病的导管介入性治疗和诊断应用中具有一定的参考价值。     

人与猪肝门静脉生物力学特性的比较研究

目的：比较研究人与猪肝门静脉生物力学特性的异同，为猪→人异种肝移植提供理论依据。方法：取人与不同月龄猪肝门静脉，利用软组织生物力学试验机测量压力一直径关系数据，推导出其弹性模量和顺应性。结果：猪肝门静脉的弹性模量随月龄的增大和血管内压力的升高而增大；顺应性则随月龄的增大而下降。与人肝门静脉相比，6月龄猪肝门静脉的弹性模量和顺应性与人相近。结论：6月龄猪肝门静脉的力学特性与成人相近，在行猪→人异种肝移植时，人与6月龄猪肝门静脉的吻合是可行的。     

Absence of bifurcation of the portal vein

Background  Absence of the horizontal segment of the left portal vein (PV) or absence of bifurcation of the portal vein (ABPV) is extremely rare anomaly. The aim of this study was to study the extra-hepatic PV demonstrating the importance of its careful assessment for the purpose of split-liver transplantation. Method  Human cadaver livers (n = 60) were obtained from routine autopsies. The cutting plane of the liver consisted of a longitudinal section made immediately on the left of the supra-hepatic inferior vena cava through the gallbladder bed preserving the arterial, portal and biliary branches in order to obtain two viable grafts (right lobe—segments V, VI, VII, and VIII and left lobe—segments II, III, and IV) as defined by the main portal scissure. The PV was dissected out and recorded for application of the liver splitting. Results  The PV trunk has been divided into right and left branch in 50 (83.3%) cases. A trifurcation of the PV was found in 9 (15.2%) cases, 3 (5%) was a right anterior segmental PV arising from the left PV and 6 (10%) a right posterior segmental PV arising from the main PV. ABPV occurred in 1 (1.6%) case. Conclusion  Absence of bifurcation of the portal vein is a rare anatomic variation, the surgeon must be cautious and aware of the existence of this exceptional PV anomaly either pre or intra-operatively for the purpose of hepatectomies or even split-liver transplantation.     

Prognostic importance of some clinical and therapeutic factors for the effect of portal vein embolization in patients with primarily inoperable colorectal liver metastases

Introduction

Portal vein embolization (PVE) may increase the resectability of liver metastases. However, the problem of PVE is insufficient growth of the liver or tumor progression in some patients. The aim of this study was to evaluate the significance of commonly available clinical factors for the result of PVE.

Material and methods

Portal vein embolization was performed in 38 patients with colorectal liver metastases. Effects of age, gender, time between PVE and liver resection, oncological therapy after PVE, indocyanine green retention rate test, synchronous, metachronous and extrahepatic metastases, liver volume before and after PVE, increase of liver volume after PVE and the quality of liver parenchyma before PVE on the result of PVE were evaluated.

Results

Liver resection was performed in 23 (62.2%) patients within 1.3 ±0.4 months after PVE. Tumor progression occurred in 9 (23.7%) patients and 6 (15.8%) patients had insufficient liver hypertrophy. Significant clinical factors of PVE failure were number of liver metastases (cut-off – 4; odds ratio – 4.7; p < 0.03), liver volume after PVE (cut-off 1000 cm³; odds ratio – 5.1; p < 0.02), growth of liver volume after PVE (cut-off 150 cm³; odds ratio – 18.7; p < 0.002), oncological therapy administered concomitantly with PVE (p < 0.003).

Conclusions

Negative clinical factors of resectability of colorectal cancer liver metastases after PVE included more than four liver metastases, liver volume after PVE < 1000 cm³, growth of the contralateral lobe by less than 150 cm³ and concurrent oncological therapy.