多普勒超声检测慢性乙型肝炎及肝硬化患者门静脉和脾静脉血流的临床意义

目的评价各型慢性乙型肝炎及肝硬化患者门静脉、脾静脉的血流动力学改变。方法将111例慢性乙型肝炎患者分成轻度组、中度组、重度组及肝硬化组。选取22例健康人为对照组。超声检测门、脾静脉内径及平均流速,计算二者血流量及血流量比值,并行组间比较。结果轻度组与对照组比较,门静脉平均流速（Vpv）、门静脉内径（Dpv）、脾静脉内径（Dsv）无统计学差异（P〉0．05）。中度组的Vpv较对照组、轻度组减慢（P〈0．05）。重度组和肝硬化组的Vpv较轻、中度组及对照组减慢（P〈0．05）。重度组Dpv、Dsv较对照组增大（P〈0．05）。肝硬化组的Dpv、Dsv较其他组增大（P〈0．01）。肝硬化组脾静脉血流量（Qsv）和脾、门静脉流量比值（Qsv／Qpv）较其他组增高（P〈0．01）。结论慢性乙型肝炎及肝硬化患者Vpv、Dpv、Dsv能反应肝脏功能损害程度,Qsv、Qsv／Qpv是反映门静脉压力的较好指标,为慢性乙型肝炎及肝硬化的临床诊断及治疗评价提供了一定帮助。     

多普勒超声评价丹参对肝硬化门静脉血流动力学的影响

目的 通过多普勒超声检测门静脉系统血流,评价丹参对肝硬化患者门静脉血流动力学影响,并探讨多普勒超声的应用价值。方法 将肝硬化患者分为丹参治疗组及对照组,分别于治疗前、治疗2周后及治疗8～12周后用彩色多普勒超声检测门静脉及脾静脉的管径、最大流速及血流量,比较治疗前后血流参数的变化。结果 丹参治疗2周及8～12周后门静脉血流速度持续加快,门静脉管径、脾静脉管径及血流量持续下降,差异有显著性,而门静脉血流量无明显变化,对照组各项血流参数无显著性变化。结论 丹参可降低门脉阻力,加快门静脉血流速度,同时降低脾静脉血流量,达到降低门脉压的效果。多普勒超声检测门脉系统血流有助于评价药物治疗门脉高压的效果。     

肝硬化门脉高压患者入肝血流的超声评价

目的观测肝硬化门脉高压患者入肝血管(肝动脉、门静脉)血流动力学,探讨其与Child-Pugh肝功能分级、临床预后的关系.方法应用彩色多普勒超声分别检测35例正常健康人和37例肝硬化门脉高压患者的人肝血管的血流参数,分析肝硬化门脉高压入肝血管血流动力学参数与肝硬化分级关系.结果肝硬化门脉高压患者门静脉内径增宽,血流速度下降,充血指数增高,肝动脉血流阻力增高,与对照组有明显差异;肝硬化门脉高压患者Child-Pugh肝功能分级与门静脉内径无显著差异(P＞0.05),Child C级门静脉血流量显著减少,Child肝功能分级与门静脉的充血指数有关.结论测定入肝血管血流动力学参数有助于判断肝硬变门脉高压症的预后,为临床诊治提供依据.     

肝硬化门静脉高压时脾、胃-肾静脉分流的超声诊断

目的探讨肝硬化门静脉高压时自发性脾、胃-肾静脉分流的彩色多普勒超声（CDFI）表现及其在诊断中的应用价值。方法回顾性分析门静脉高压时自发性脾、胃-肾静脉分流的21例CDFI图像特征。结果（1）自发性脾、胃-肾静脉分流声像图特点是脾、胃区与左肾之间异常走行的迂曲管道,频谱多普勒示其内血流为类似门静脉样频谱,动态观察可见其与左肾静脉相通;（2）在分流支较为粗大时可有间接的声像图表现：肝侧脾静脉内为离肝血流信号;左肾静脉内径增宽、血流速度增快及频谱形态改变。结论门静脉高压时自发性脾、胃-肾静脉分流具有典型的CDFI图像,可作为超声诊断的重要依据。     

肝硬化患者腹腔镜胆囊切除术前彩色多普勒超声应用价值

目的探讨彩色多普勒超声在肝硬化患者腹腔镜胆囊切除术（Laparascopic cholecystectomy，LC）术前的应用价值。方法肝硬化胆石症纽35例．依据肝功能Child-Pugh分级标准分为3个亚组，正常对照组20例。运用彩色多普勒超声检测门脉系血管，测量门静脉最大内径、门静脉平均血流速度等血流动力学参数。结果门静脉平均血流速度随肝功能分级而逐渐降低，组间和组内均存在显著性差异（P〈0．01，P〈0．05）；门静脉内径组间存在差异（P〈0．05），组内无显著性差异；除脐静脉重开外，其余门脉系血管内径增粗在Child-Pugh分级B、C二级存在较大重叠。结论彩色多普勒有助于全面评估门静脉压力和门脉侧支开放及代偿情况，为筛选LC手术病人提供重要依据。     

肝硬化食管静脉曲张破裂出血患者门静脉血流参数的变化

目的 探讨彩色多普勒超声预测肝硬化门静脉高压症(cirrhotic portal hypertension)患者食管静脉曲张破裂出血的应用价值.方法 肝硬化门静脉高压症患者81例,根据有无出血史分为出血组(36例),非出血组(45例).应用彩色多普勒超声分别检测两组的门静脉(pv)和脾静脉(sv)内径(Dpv、Dsv)、血流动力学参数并进行对比分析.结果 门静脉和脾静脉的内径、血流速度(Vpv、Vsv)及脾静脉的血流量(Qsv)在两组间差异均有统计学意义(P<0.05),但门静脉血流量(Qpv)在两组间差异无统计学意义(P>0.05).结论 彩色多普勒超声检测肝硬化门静脉高压症患者门静脉和脾静脉内径及血流动力学参数,对预测肝硬化门静脉高压时食管静脉曲张破裂出血是有价值的.     

彩色多普勒检测肝硬化门脉高压症手术前后血流动力学变化的价值

应用彩色多普勒对肝硬化门脉高压患者手术前后门脉系血流变化进行检测。结果；观察组术前ＰＶ、ＳＶ内径及血流量增加，血流速度减慢是本病血流动力学的重要变化，而血流速度减低与血流阻力指数增高又有一定的敏感性；术后其内径变窄，血流量减少，仍与对照组有显著差异（Ｐ＜０．０１）。     

彩色多普勒超声对失代偿性肝硬化患者自体骨髓干细胞移植治疗前后的对比观察

目的探讨彩色多普勒超声评价自体骨髓干细胞移植治疗乙型肝炎肝硬化失代偿期患者疗效的应用价值。方法经肝动脉行自体骨髓干细胞移植治疗的乙型肝炎肝硬化失代偿期患者43例,分别于治疗前1～3d内,治疗后第3个月和6个月观察患者腹水情况,肝脏形态和内部回声变化,以及门静脉系统血流颜色变化,并用超声测量肝脏门静脉内径和门静脉血流速度;脾脏厚径、脾静脉内径和脾静脉血流速度。结果①与术前比较,自体骨髓干细胞移植术后第3个月腹水量减少者35例,肝脏形态和内部回声无明显变化,门静脉和脾静脉血流颜色变明亮,门静脉血流速度增快(P<0.01);脾脏缩小,脾静脉内径变窄,以及脾静脉血流速度增快(P<0.05)。②与术前比较,术后第6个月腹水量减少者41例,且其中15例完全消失,门静脉和脾静脉血流颜色明亮,肝脏形态和内部回声未见明显变化,门静脉内径变细(P<0.05),门静脉血流速度明显增快(P<0.01);脾脏明显缩小,脾静脉内径变窄,脾静脉血流速度明显增快(P<0.01)。术后3个月与6个月比较,其门静脉血流速度,脾脏厚径减小,脾静脉内径变小,脾脏静脉血流速度增快,差异均有统计学意义(均P<0.05)。结论彩色多普勒超声通过观察门静脉系统血流颜色及血流动力学变化,对临床评价自体骨髓干细胞移植治疗乙型肝炎肝硬化失代偿期患者的效果有重要的指导意义。     

Color Doppler velocity profile assessment of portal hemodynamics in cirrhotic patients with portal hypertension: correlation with esophageal variceal bleeding

PURPOSE: Using the color Doppler velocity profile (CDVP), we investigated portal hemodynamics and their relationship with esophageal variceal bleeding (EVB) in patients with cirrhosis and portal hypertension. METHODS: The hemodynamics of the portal trunk, right anterior portal branch, and splenic vein were evaluated in 69 cirrhotic patients with portal hypertension and 46 healthy volunteers. The CDVP, a recently developed Doppler software, was used to measure blood flow velocity and flow volume; evaluate the spatial distribution of flow velocities in the cross-section of a vessel (velocity profile), as reflected by the profile parameter (n); and assess changes in flow volume over time (flow profile). The congestion index was calculated by dividing the cross-sectional area by the maximum cross-sectional velocity (CSVmax). The hemodynamic features were compared between patients without a history of EVB [EVB(-)] and those with a history of EVB [EVB(+)], and a logistic regression model was employed to identify factors associated with EVB. RESULTS: Compared with the healthy group, the cirrhotic group had a significantly lower mean CSVmax in the portal trunk and right anterior portal branch (both p < 0.01), a significantly elevated mean flow volume in the splenic vein and portal trunk (both p < 0.01), a significantly elevated mean ratio of splenic vein flow volume to portal trunk flow volume (SV/PT) (p < 0.001), and a significantly greater mean congestion index in the portal trunk, right anterior portal branch, and splenic vein (all p < 0.01). In the cirrhotic group, there was a significantly higher incidence of a flat flow pattern in the right anterior portal branch and a phasic flow pattern in the splenic vein than in the healthy group (both p < 0.01). Among cirrhotic patients, the EVB(+) group had a significantly greater mean flow volume in the splenic vein (p < 0.01), greater mean SV/PT (p < 0.01), greater mean spleen size (p < 0.05), and lower mean portal trunk n value (p < 0.05) compared with the EVB(-) group. Logistic regression analysis revealed that the SV/PT and portal trunk n value were independent EVB-related factors. CONCLUSIONS: The results suggest that portal hemodynamics in cirrhotic patients are characterized by passive congestion and increased blood flow. However, these 2 features had different preponderances in different parts of the portal venous system. Increased flow in the splenic vein may be the primary source of increased portal flow and may play a role in the development of EVB. The SV/PT and portal trunk n value may be valuable factors for predicting EVB.     

多层螺旋CT门静脉成像对肝硬化分级及食管静脉曲张出血分析

目的分析肝硬化门脉高压患者门静脉系统血管径线变化及与食管静脉曲张出血的关系,探讨多层螺旋CT门静脉成像（MSCTP）在肝硬化分级及食管静脉曲张出血中的临床价值。方法使用多层螺旋CT对200例对照组及63例肝硬化患者（出血组31例、非出血组32例）的门静脉、脾静脉和肠系膜上静脉直径及门静脉长度的测定,比较门静脉诸血管参数在对照组与肝硬化组、不同肝硬化分级间及食管静脉曲张出血间有无差异。结果肝硬化组门静脉上述参数均大于对照组（P〈0．01）,但在肝硬化分级中除肠系膜上静脉Child—Pugh C级较A与B级增宽外,其他参数差异均无统计学意义（P〉0．05）。出血组的门静脉参数较非出血组除门静脉长度外均有增大（P〈0．05）。结论MSCTP能够反映肝硬化门静脉高压的程度,并对预测食管静脉出血有重要临床意义。     

声触诊组织量化技术在预测乙型肝炎后肝硬化食管静脉曲张发生风险中的价值

目的探讨常规超声与声触诊组织量化（VTQ）技术在肝硬化食管静脉曲张（EV）发生风险中的诊断效能及临床价值。 方法选取2015年12月至2016年12月在吉林大学中日联谊医院就诊的154例肝硬化患者,其中经胃镜检查结果证实：无静脉曲张组（NEV）52例,EV组102例。采用常规超声检测右肝斜径、脾脏厚径、脾脏长径、肝门静脉和脾静脉的内径及血流速度,并应用VTQ技术检测肝脏和脾脏的剪切波速度（SWV）值。采用Logistic回归分析筛选影响EV发生的独立危险因素;进而采用ROC曲线判断相关独立危险因素预测肝硬化EV发生的诊断效能。 结果EV组的肝功能Child Pugh分级明显高于NEV组,差异有统计学意义（χ²=50.74,P<0.05）;EV组的肝门静脉和脾静脉内径以及肝脏和脾脏的SWV值均明显大于NEV组,但肝门静脉及脾静脉的血流速度均明显低于NEV组,差异均有统计学意义（t=1.62、0.03、3.66、3.92、-0.18、-0.10,P均<0.05）。Logistic回归分析结果显示肝门静脉内径、肝脏及脾脏SWV值为预测EV发生的独立危险因素,其OR值分别为2.396、1.007、1.005（P均<0.05）。肝门静脉内径、肝脏及脾脏SWV值的AUC分别为0.88（95%CI：0.824~0.936）、0.911（95%CI：0.866~0.957）及0.908（95%CI：0.863~0.953）;最佳临界值分别为14.05 mm、2.013 m/s及2.937 m/s;其敏感度分别为73.6%、82.4%、79.6%;特异度分别为87.1%、90.3%、87.6%;准确性分别为82.5%、87.7%、85.1%。 结论肝门静脉内径、肝脏和脾脏SWV值为预测EV发生的独立危险因素,三者在评估肝硬化EV发生风险中有较好的诊断效能,尤其是肝脏SWV值。     

慢性肝炎彩色多普勒血流成像与肝功能损害程度相关性研究

目的探讨慢性肝炎门静脉血流动力学改变的超声测值与慢性肝功能损害程度的相关性。方法对60例不同程度慢性乙型肝炎患者和60例对照组进行门静脉血流动力学改变的超声测量（门静脉内径、门静脉截面积、门静脉最大流速和门静脉充血指数）,结果与肝功能损害程度相比较：结果慢性肝炎轻度组,门静脉内径较对照组增宽、截面积增大,但差异无显著性意义（P〉0.05）,中度组、重度组门静脉内径增宽、截面积增大明显,与对照组、轻度组比较,差异有显著意义（P〈0.05）．门静脉最大流速在轻度组略减低,与对照组比较差异无显著意义（P〉0.05）,中度组重度组的门静脉最大流速明显减低,与对照组比较差异有显著性意义（P〈0.01）。CI值随着病情进展逐渐增高,差异有显著性意义（P〈0．05）。结论慢性肝炎患者门静脉血流动力学参数能反映肝脏肝功能损害程度,对慢性肝炎的临床治疗评价有一定的价值。     

Value of Doppler sonography in assessing the progression of chronic viral hepatitis and in the diagnosis and grading of cirrhosis.

OBJECTIVE: The purpose of this study was to evaluate the value of Doppler sonography in assessing the progression of chronic viral hepatitis and in the diagnosis and grading of cirrhosis. METHODS: Abdominal sonographic and liver Doppler studies were performed in 3 groups: 36 patients with chronic viral hepatitis, 63 patients with cirrhosis, and 30 control subjects with no evidence of liver disease. A series of Doppler indices of hepatic vascularity, including portal vein velocity, portal vein pulsatility score, flow volume of the portal vein, resistive and pulsatility indices of the hepatic artery, modified hepatic index, hepatic vascular index, waveform of the hepatic vein, and focal acceleration of flow, were measured and correlated with liver and spleen size, portal and splenic vein diameter, and presence of ascites and collateral vessels. These indices were compared across the 3 study groups and within the patient groups with respect to presence of inflammation, fibrosis, and steatosis, as determined by histologic evaluation. RESULTS: The most useful indices were portal vein velocity, the modified hepatic index, and nontriphasic flow in the hepatic vein, which were helpful in distinguishing patients from control subjects. Hepatic vascular and modified hepatic indices were useful for differential diagnosis of cirrhosis and chronic viral hepatitis. However, all measurements were limited in their ability to determine the severity of chronic hepatitis. CONCLUSIONS: Doppler sonography is sensitive to hemodynamic alterations resulting from inflammation and fibrosis, and if sonography is the study of choice to follow the progression of hepatitis, it will not be adequate without Doppler imaging. Doppler sonography has high diagnostic accuracy in cirrhosis despite some false-positive conditions. However, it has a limited role in clinical grading.     

Effect of cisapride on portal haemodynamics in patients with liver cirrhosis using duplex Doppler ultrasonography.

PURPOSE: Cisapride, a benzimide derivative, is a gastrointestinal prokinetic agent without dopamine-antagonistic or cholinomimetic effects. This study aims at assessing the effect of cisapride oral administration on portal flow in patients with advanced post hepatitic cirrhosis using duplex Doppler ultrasound (US). METHODS: A total of 12 patients with post-hepatitic liver cirrhosis were included in the study. Duplex Doppler sonographic examinations were performed before and after treatment. The subjects received 10 mg cisapride before starting the measurement procedure and then three times a day for 2 days. Portal haemodynamics including vessel diameters (mm), mean flow velocities (cm/s), blood flows (ml/min) were investigated. RESULTS: Mean portal vein diameters, mean portal flow velocity and portal blood flow volume showed decreases of 18.6, 22.1 and 43.6% (P<0.001), respectively. After cisapride administration the portal vein diameter did not change in two patients and the portal vein velocity did not change in three patients. No significant change was found in systolic blood pressure, diastolic blood pressure or pulse rate after the administration of cisapride. CONCLUSION: In this study, it was demonstrated that oral administration of cisapride results in a significant reduction of portal blood flow but there were no changes in heart rate or systolic pressure in patients with cirrhosis of the liver.     

彩色多普勒检测正常肝脏慢性肝炎肝硬化的门静脉左右支及脾静脉血流动力学改变

本研究采用彩色多普勒超声对５０例正常肝、１７例慢性肝炎、３９例肝硬化门静脉的右前支，左支矢状段，脾门静脉进行血流动力学测定。结果显示慢肝时脾静脉血流量增大非常显著；肝硬化时左支矢状段血流速度和血流量均显著增大，ＶＬＰＶ／ＶＲＡＰＶ、ＱＬＰＶ／ＱＲＡＰＶ比值明显升高。笔者认为多普勒超声对慢肝患者脾静脉血流量的测定可判断门脉压力升高的程度，间接提示肝损害的程度。ＶＬＰＶ／ＶＲＡＰＶ、ＱＬＰＶ／ＱＲＡＰＶ比值的升高为诊断门脉高压症的重要指标之一。     

用超声多普勒对门脉高压症及门奇断流术后门脉系统血液动力学的观察

本文应用超声多普勒复合装置观察了门脉高压症病人门奇断流术前后的血液动力学。结果显示,门脉高压症病人门静脉血流量明显增多,脾循环处于高动力状态,对门脉高压形成有重要作用。门脉高压症病人脾、肠血流间存在能互相代偿的关系,脾、肠血流量之和大于门静脉血流量,说明门静脉有自发性分流存在。门奇断流术后,门静脉血流量减少约25％,肠系膜上静脉流量增加约60％。断流术后门静脉压较术前无明显变化。     

门静脉彩色多普勒超声诊断肝硬化的意义

目的：总结门静脉（PV）彩色多普勒（CDFI）超声对诊断肝硬化的意义。方法：运用CDFI超声检查了30例肝硬化患者的PV,并按Puph肝功能分级法进行统计学处理,与正常组30例进行对比分析。结果：PV内CDFI可显示本色、红色、混色或充盈缺损。PW可显示血流速度正常,减低或双向血流。血流速度、血流量随着Puph肝功能分级程度严重而下降,与正常组比较有显著差异（P＜0．05）。脾静脉（SV）内探及类动脉频谱,增厚的阳囊壁内可显示胆囊壁静脉。结论：CDFI检测门静脉不仅能诊断肝硬化,而且能判断肝硬化损害的程度。     

门静脉高压症介入治疗前后血流动力学变化分析

目的探讨肝炎后门静脉高压症的多重介入治疗方法的可行性.方法分析22例部分脾动脉栓塞术和12例行经颈内静脉肝内门体分流术并胃冠状静脉栓塞术患者的彩色多普勒检查资料.结果经颈内静脉肝内门体分流术并胃冠状静脉栓塞术后脾静脉、门静脉管径缩小(P<0.05),门静脉、脾静脉流速流量明显增加,呈高动力状态.部分脾动脉栓塞术后脾静脉、门静脉平均血流速度降低(P<0.05),血流量明显减少(P<0.01).结论经颈内静脉肝内门体分流术并胃冠状静脉栓塞术若与部分脾动脉栓塞术联合运用可缓解门脉系循环高动力状态、降低门静脉压力.     

彩色多普勒超声对肝硬化门静脉高压症脾动脉栓塞术前后脾脏及脾静脉血流动力学变化的研究

目的： 观察肝硬化门静脉高压症患者行脾动脉栓塞术前后脾脏及脾静脉血流动力学变化。方法： 栓塞术前后对 １２ 例患者采用彩色多普勒超声检查进行观察。结果： 脾动脉栓塞后脾静脉、门静脉管径缩小 （Ｐ＜ ０．０１）。脾静脉、门静脉平均血流速度降低 （Ｐ＜ ０．０５）, 血流量明显减少 （Ｐ＜ ０．０１）。栓塞前后脾静脉流速与门静脉主干流速比值及脾静脉与门静脉主干流量比值比较无明显差异 （Ｐ＞ ０．０５）。从而证实在肝硬化门静脉高压形成后, 脾静脉血流量增加是门静脉高压时门静脉血流量增加的重要因素。结论：脾动脉栓塞术是缓解脾循环高动力状态间接降低部分门静脉压力的有效方法之一。远期疗效有待进一步观察。     

肝硬化患者血浆ET-1、NO与门脉血流量测定及其意义

目的 研究肝硬化患者不同肝功能状态下血浆ET—1、NO及门脉血流量(Qpv)的变化规律并探讨三者间的关系。方法 采用放射免疫分析法、分光光度法及彩色多普勒超声检查，测定30饲肝硬化患者血浆ET-1、NO及门静脉宽度(Dpv)、门静脉血流速度(Vpv)并与8饲健康献血员进行对比分析。结果 肝硬化组血浆ET—1、NO均显著高于正常对照组；其门静脉血流量(Qpv)显著低于正常对照组。根据肝功能Child—pugh分级，肝功能A级与对照组对照，ET—1、NO均无显著性差异，Qpv有显著性差异；B级与A级、C级与B级间上述三指标均有显著性差异。结论 肝硬化患者血浆ET—1、NO升高，Qpv减少。ET—1、NO参与了肝硬化功能的损害及门脉高压的形成和发展。