彩色多普勒超声对门静脉内应用PVA复制肝内型门脉高压症犬的血流动力学观察

选杂交犬８只，门静脉内反复注射聚乙烯醇（ＰＶＡ）复制门脉高压症动物模型。６只形成肝内型门脉高压症动脉模型，２只死于术后感染。用药前后，应用彩色多普勒超声技术观察全部实验动物肝脏血流动力学指标，结果显示门静脉、脾静脉血流量有不同程度增加（Ｐ值＜０．０１），３只家犬肠系膜上静脉血流量略有增加（Ｐ值＞０．０５），为门脉高压症的早期诊断提供了重要的血流动力学参数     

多普勒超声检测肝硬化门静脉和脾静脉血流量的临床意义

目的：本研究旨在探讨多普勒超声检测脾静脉血流量大于门静脉血流量与肝硬化门静脉系统食管胃底静脉曲张及其破裂出血的关系。方法：对５８例肝硬化患者门脉系统血流进行彩色多普勒血流检测,其中３０例患者脾静脉血流量大于门静脉血流量（即ＱＳＶ＞ＱＰＶ）,２８例患者门静脉血流量大于脾静脉血流量（即ＱＰＶ＞ＱＳＶ）,所有患者均在三个月内同时或先后进行电子胃镜及上消化道造影检查,确定食管胃底静脉曲张或破裂出血的发生率。结果：ＱＳＶ＞ＱＰＶ组的脾静脉血流量、脾静脉直径、脾脏厚度均大于ＱＰＶ＞ＱＳＶ组的测值,而其门静脉直径及血流量均小于ＱＰＶ＞ＱＳＶ组的测值。经电子胃镜及上消化道造影检查证实,ＱＳＶ＞ＱＰＶ组患者食管胃底静脉曲张发生率及曲张静脉破裂出血率均较ＱＰＶ＞ＱＳＶ组明显增高。结论：脾静脉血流量超过门静脉血流量与食管胃底静脉曲张及其破裂出血有密切关系。一旦多普勒超声检测出现脾静脉血流量高于门静脉血流量这一血流动力学改变,则预示肝硬化患者多有门－体侧支循环开放,即静脉曲张,并有破裂出血倾向。     

肝硬化病人门静脉高压症的多普勒超声研究

为了解肝硬化门脉病人门脉系统循环情况及为临床门脉高压的药物治疗提供客观依据、应用彩色多普勒超声检测２０例肝硬化病人及１５例正常人门脉系统血流动力学改变。结果；肝硬化门脉高压症病人门静脉，脾静脉，肠系膜上静脉的血管直径，血流速度，血流量均大于正常人，而且发现门静脉血流量增加主要是脾静脉血流量增加所致。     

肝硬化病人门静脉高压症的多普勒超声研究

为了解肝硬化门脉高压病人门脉系统循环情况及为临床门脉高压的药物治疗提供客观依据，应用彩色多普勒超声检测２０例肝硬化病人及１５例正常人门脉系统血流动力学改变。结果：肝硬化门脉高压症病人门静脉、脾静脉、肠系膜上静脉的血管直径、血流速度、血流量均大于正常人（Ｐ＜０００５），而且发现门静脉血流量增加主要是脾静脉血流量增加所致．结论：肝硬化门脉高压病人存在门脉高动力循环状态，这对临床选择有效的治疗门脉高压症的方法有重要价值。     

脉冲多普勒超声观测肝硬化门脉高压患者脾切除加断流术前后门脉系统血流动力学改变

应用脉冲多普勒超声观测11例肝硬化门脉高压患者脾切除加断流术前后门脉系统血流的最大流速、血流量、血管直径及淤血指数。结果:脾切除加断流术后门脉主干、左支矢状部及右支血流量下降,肠系膜上静脉血流量增加,手术前后的自由门脉压与淤血指数无明显改变;术前自由门脉压与淤血指数呈正相关;术后门脉主干和左支矢状部的血流量减少量与脾静脉的血流量均呈正相关(P<0.01)。本文全面反映了手术前后肝内外门脉各属支的血流动力学变化。     

彩色多普勒超声观测肝硬化门静脉高压症部分脾动脉栓塞术？…

目的 探讨彩多普勒超声观察肝硬化门静脉高坟症患者行部分脾动脉栓塞术的临床应用价值。方法 在２８例肝炎后肝硬化门静脉高压症患者,于部分脾动脉栓塞术前后对肝脾血流动力学变化做定量分析和对比研究。结果 与术前相比,手术后２周的门、脾静脉血流量参数降低（Ｐ〈０．０５）,血管内径缩小（Ｐ〈０．０１）。术后半年,三条血管血流量参数和平均血流速度垒是一步降低（Ｐ〈０．０１）,门、脾静脉血流量参数的减少与脾动脉血     

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。     

彩色多普勒超声对门静脉内应用PVA复制肝内型门脉高压症犬的血…

选杂交犬８只，门静脉内反复注射聚乙烯醇复制门脉高压症动物模型。６只形成肝内型门脉高压症动脉模型，２只死于术后感染，用药前后，应用彩色多普勒超声技术观察全部实验动物肝脏血流动力学指标，结果显示门静脉，脾静脉血流量有不同程度增加（Ｐ值〈０．０１），３只家犬肠系膜上静脉血流量略有增加（Ｐ值〉０．０５），为门脉高压症的早期诊断提供了重要的血流动力学参数。     

超声检测脾脏自发性血液分流对肝硬化患者门静脉血流动力学的影响

目的 探讨超声检测肝硬化脾脏自发性血液分流与门静脉血流动力学变化之间的关系.方法 87例患者分为慢性肝炎组、肝硬化组、对照组;根据Child-Pugh分级标准将肝硬化患者肝脏功能分为Child A组和Child B/C组.静息状态下分别测量肝动脉、门静脉、肠系膜上动静脉、脾动静脉等血管的血流动力学参数,分别计算脾静脉、肠系膜上静脉分流率;脾静脉、肠系膜上静脉与门静脉血流量比值,以及各试验组患者的肝循环指数.分析脾脏自发性血液分流对门静脉血流动力学的影响以及与肝循环指数之间的关系.结果 门静脉血流量各试验组间差异无统计学意义,但肝硬化组脾静脉血流量明显增加,与对照组和慢性肝炎组比较差异有统计学意义;肝硬化组脾静脉与门静脉血流量比值大于1,脾静脉分流率肝硬化组与对照组和慢性肝炎组比较差异有统计学意义.肝功能Child B/C级组脾静脉分流率明显大于Child A级组,脾静脉所占门静脉血流量比值随着肝脏功能的减低而增加,肠系膜上静脉所占门静脉血流量比值逐渐减低,脾静脉与肠系膜上静脉血流量比值增加.脾静脉血流量占门静脉血流量比值与肝循环指数之间呈非线性负相关.结论 脾脏自发性血液分流与脾脏高动力循环互相影响,同时对于肝脏的血流灌注有重要作用,检测Vspv/Vpv比值可初步判定肝硬化患者的肝脏储备功能.     

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？…

目的：观察肝硬化门静脉高压症患者行脾动脉栓塞前后脾脏及脾静脉血流这变化。方法：栓塞 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。脾静脉、门静脉平均血流速度降低,血流量明显减少,栓塞前后脾静流速与门静脉主干流速比值及脾静脉与门静脉主干流量幽会比较无明显差异。从而证实在肝硬化门静脉高压形成后,脾静脉血汉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     

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。     

彩色多普勒超声对经颈静脉肝内门体分流术前后血流动力学的研究

本文应用彩色多普勒超声对１９例肝硬化门脉高压症的门脉系统血流动力学在经颈静脉肝内门体分流术（ＴＩＰＳＳ）前后进行研究。结果表明Ｂ型超声可以清晰显示支架回声。ＣＤＦＩ可以清楚显示支架内血流通畅情况。术后门静脉、脾静脉血流速度、血流量显著增加，肝内门静脉分支血流速度显著减慢，血流量显著减少。门静脉左矢状支８／１２（６７％）例次，右前支７／１２（５４％）例次出现反向血流。我们认为ＣＤＦＩ对于估价ＴＩＰＳＳ术后门静脉系统血流动力学变化有重要价值。     

超声检查附脐静脉开放腹壁静脉曲张在门静脉高压临床分型的意义

目的应用彩色多普勒超声对门静脉高压附脐静脉开放和腹壁静脉曲张门腔之间侧支循环进行研究,确定门脉高压分型。方法超声检查86例肝硬化门静脉高压、13例布加综合征及6例门静脉主干、脾静脉血栓3组门静脉高压患者的腹壁静脉曲张门腔之间侧支循环吻合情况及血流方向。结果肝硬化门静脉高压组腹壁静脉曲张在脐以上血流流向头端,而脐以下血流流向腹端。布加综合征合并下腔静脉阻塞组,血流均流向上胸端。门静脉主干、脾静脉血栓未见脐静脉开放及腹壁静脉曲张。结论应用彩色多普勒超声判断附脐静脉开放和腹壁静脉曲张门腔之间侧支循环的情况,可明确血管阻塞部位、程度、范围,为肝前、肝内及肝后门静脉高压分型的诊断提供有效依据,对临床制定合理治疗方案具有指导意义。     

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。     

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 splanchnic Doppler ultrasound in the diagnosis of portal hypertension

The accuracy of various Doppler parameters of portal circulation in the diagnosis of relevant portal hypertension (presence of gastroesophageal varices) was prospectively validated. The following parameters were compared in 51 patients with chronic liver disease (40 with cirrhosis and 11 with chronic hepatitis): portal vein flow velocity and congestion index, hepatic and splenic arteries resistance indexes (RI), modified liver vascular index (portal flow velocity/hepatic artery RI) and portal hypertension index, a new index calculated as: [(hepatic artery RI x 0.69) x (splenic artery RI x 0.87)]/portal vein flow velocity. Highest accuracy was achieved by the splenic artery RI and the portal hypertension index (both around 75%) at cut-offs, respectively, of 0.60 and 12 cm/s(-1), which appeared to be, therefore, the most favorable parameters for the clinical practice. Their use may limit the need for endoscopy to search for varices.     

Accessory ultrasonographic findings in chronic liver disease: diameter of splenic and hepatic arteries, fasting gallbladder volume, and course of left portal vein

We have assessed the incidence and significance of changes in the caliber of the splenic and hepatic arteries, in fasting gallbladder volume, and in the intrahepatic course of the left portal vein in a group of 46 patients affected by chronic liver disease (24 with chronic active hepatitis and 22 with liver cirrhosis). Thirty normal subjects were examined as a control group. Mean diameters of the splenic and hepatic arteries were significantly greater in cases of liver cirrhosis than in the control group. In the case of chronic active hepatitis, only the splenic artery proved significantly enlarged in comparison with the control group. These results demonstrate that caliber modification occurs in the splenic and hepatic arteries during chronic liver disease. In particular, changes in the splenic artery precede the onset of clinically evident portal hypertension. Gallbladder volume was significantly increased in patients affected by liver cirrhosis. Finally, statistical analysis did not reveal any significant difference in the angles formed by the transverse and longitudinal tracts of the left portal vein in controls and in subjects with liver disease.     

The stage of portal blood flow in patients with hemoblastosis combined with chronic hepatitis

109 patients with hemoblastosis (HB) were examined. Average age was 31.8 +/- 1.4 years in group of lymphogranulomatosis patients, and 44 +/- 5.3 years in group of acute leukemia patients. Group of 46 patients with clinical laboratory signs of hepatic lesion was marked out. Since features of portal blood flow (PBF) revealed at dopplerography did not depend on hepatitis aetiology, all patients with chronic hepatitis were analyzed in one group. These patients were examined clinicobiochemically: functional hepatic tests, markers of viral hepatitis B and C, ultrasonic abdominal scanning, PBF dopplerography, puncture biopsy of hepar. All patients had PBF disturbances such as decrease of portal vein blood flow, increase of venous drainage of hepar and spleen. The degree of disturbances intensity increased depending on degree of chronic hepatitis activity (the index of histological activity) and hepatic fibrosis stage. Thus, presence of chronic hepatitis in HB patients regardless of aetiology, is the factor aggravating patients' stage and corrupting PBF. PBF disturbances (decrease of arterial and venous inflow and increase of venous outflow) and development of fibrous changes apparently related with compression of vessels by connective tissue around central veins, inside of lobules and among of hepatic cells. Consequence of it is including anastomosises in blood flow which leads to redistribution of PBF and portal hypertension forming.     

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.