彩色多普勒在门静脉穿刺注药治疗肝癌中的应用

本文探讨了彩色多普勒在门静脉穿刺注药治疗肝癌中的应用价值。对15例原发性肝癌和1例继发性肝癌患者门静脉穿刺注药前后及注药过程中彩色多普勒的应用表明;注药前彩色多普勒对肝肿瘤病灶及门脉血流动力学的检查有助于本治疗适应证的选择;注药过程中的彩色多普勒应用,有助于提高静脉穿刺注药的准确性和观察药液在肝内的弥散;注药后彩色多普勒检查及其穿刺活检有助于对肝癌疗效的观察;超声引导下的门静脉穿刺导向化疗,作为肝癌综合治疗的方法之一,值得进一步探讨。     

门静脉的CT血管造影

CT门静脉血管成像是目前临床上广泛应用的无创性门静脉成像技术 ,可以显示门静脉的正常解剖及变异 ,有利于显示肝脏分段 ,门静脉高压所致的静脉曲张 ,经颈静脉门体分流术前、后的评价门静脉栓塞和海绵样变性 ,胰腺癌及其他恶性肿瘤手术可切除性的评价 ,肝移植术前后的评价 ,具有重要的临床应用价值。     

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.     

A comparison of duplex Doppler sonography of the ligamentum teres and portal vein with endoscopic demonstration of gastroesophageal varices in patients with chronic liver disease or portal hypertension, or both.

The ability of duplex Doppler sonography of the ligamentum teres and portal vein to detect specific signs of portal hypertension was compared with the ability of endoscopy to demonstrate gastroesophageal varices in consecutive patients. Among 90 patients with parenchymal liver disease and a high probability of portal hypertension, 70 had varices, 72 had specific sonographic signs, and four had neither. Ultrasonography was comparable to endoscopy irrespective of the clinical severity of the underlying liver disease. Eleven patients had vascular occlusive diseases; nine had varices; and all had at least one sonographic sign. Duplex Doppler ultrasonography may have a clinical role in noninvasive detection of portal hypertension. Further studies correlating the findings with those of portal pressure are needed to define the place of duplex Doppler ultrasonography as a predictor of the presence of portal hypertension.     

肝脾联合切除和胃左血管离断术治疗肝癌合并门脉高压症的临床意义

目的:探讨原发性肝癌合并门脉高压患者行肝脾联合切除、胃左血管离断的临床意义.方法 回顾分析26例原发性肝癌合并门脉高压症患者,行肝脾联合切除、胃左血管离断术14例(联合切除组),行单纯肝癌切除组12例(单独切除组),比较两组的术后并发症、血常规变化,术后两年肿瘤的复发率、死亡率及上消化道出血率.结果 术前两组之间基本...     

Systemic lupus erythematosus complicated by noncirrhotic portal hypertension: A case report and review of literature

A 48 year-old Chinese woman suffering from polyarthritis, irregular fever and trichomadesis was admitted to the hospital. A diagnosis of systemic lupus erythematosus (SLE) was made based on polyarthritis, pancytopenia, reduced complement 3, multiple positive autoantibodies, a positive Coomb’s test and protein in her urine. In addition, splenomegaly was detected during physical examination and confirmed by abdominal ultrasonography and magnetic resonance imaging, indicating that the patient had SLE and portal hypertension. Further negative investigations ruled out the possibility of cirrhosis. The patient was diagnosed with active SLE complicated by noncirrhotic portal hypertension (NCPH) without liver histopathology, due to the patient’s refusal for liver biopsy. Portal vein diameter and splenomegaly decreased following treatment with methylprednisolone, hydroxychloroquine and metoprolol tartrate. To date, SLE complicated by NCPH has rarely been reported, as it is under-recognized clinically as well as pathologically. Here we describe a case of SLE complicated by NCPH and review the literature for its characteristics, which may contribute to improving the recognition of NCPH and reducing missed and delayed diagnosis of this disorder.     

Portal hypertension exacerbates intrahepatic portosystemic venous shunt and further induces refractory hepatic encephalopathy: A case report

BACKGROUNDIntrahepatic portosystemic venous shunt (IPSVS) is a rare hepatic disease with different clinical manifestations. Most IPSVS patients with mild shunts are asymptomatic, while the patients with severe shunts present complications such as hepatic encephalopathy. For patients with portal hypertension accompanied by intrahepatic shunt, portal hypertension may lead to hemodynamic changes that may result in exacerbated portal shunt and increased shunt flow.CASE SUMMARYA 57-year-old man, with the medical history of chronic hepatitis B and liver cirrhosis, was admitted to our hospital with abnormal behavior for 10 mo. He had received the esophageal varices ligation and entecavir therapy 1 year ago. Comparing with former examination results, the degree of esophageal varices was significantly reduced, while the right branch of the portal vein was significantly expanded and tortuous. Meanwhile, abdominal ultrasound presented the right posterior branch of portal vein connected with the retrohepatic inferior vena cava. The imaging findings indicated the diagnosis of IPSVS and hepatic encephalopathy. Instead of radiologic interventions or surgical therapies, this patient had only accepted symptomatic treatment. No recurrence of hepatic encephalopathy was observed during 1-year follow-up.CONCLUSIONHemodynamic changes may exacerbate intrahepatic portosystemic shunt. The intervention or surgery should be carefully applied to patients with severe portal hypertension due to the risk of hemorrhage.     

小儿门静脉海绵样变性、门静脉高压症的临床研究(附10例报告)

目的：探讨门静脉海绵样变性、门静脉高压症的病因、病理、临床表现、诊断方法、治疗及预后等问题。方法：总结我院7例经手术治疗病例的临床及影像学检查资料。结果：呕血伴排柏油样便为主要临床表现，脾脏增大为体检特征。本组均经彩色多普勒检查提示或明确诊断，4例术前行血管造影。胃底及下段食管血管断流、脾切除为共有手术方式，5例行不同形式的分流手术。结论：部分患儿可能为先天性因素所致。本症诊断主要靠影像学检查，治疗同一般门静脉高压症，预后与肝脏情况密切相关。     

肝癌的“双灌注”加部分脾栓塞治疗

目的　探讨肝癌的“双灌注”加部分脾栓塞术治疗价值。方法　 38例肝癌行肝动脉灌注化疗与栓塞、脾动脉或肠系膜上动脉灌注化疗加部分脾栓塞治疗。结果　患者术后血象好转 ,门脉高压症状减轻 ,肝功能改善 ,1,2 ,3年生存率分别为 6 3.2 %,42 .1%,2 6 .3%。结论　肝癌“双灌注”加部分脾栓塞术是治疗肝癌特别是伴有门脉高压、脾功能亢进的肝癌的一种安全有效的方法 ,对伴有门静脉癌栓、肝动脉 门静脉瘘者也同样有效。     

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。     

3.0T MR反转时间对流入反转恢复序列门静脉成像质量的影响

目的 探讨3.0T MR 反转时间（TI）对流入反转恢复序列（IFIR）门静脉系统非对比增强图像质量的影响。方法 对健康志愿者 31名（正常组）、门静脉高压患者12例（门静脉高压组）采用不同的TI行冠状位IFIR序列扫描。评估采用不同TI所得的IFIR图像的门静脉主干SNR、主动脉SNR、肝脏组织SNR、门静脉主干CNR,根据门静脉及其分支显示清晰程度进行评分。对上述指标的比较采用单因素方差分析或配对t检验。结果 两组受检者不同TI图像的门静脉主干SNR和CNR差异均无统计学意义（P均>0.05）。正常组肝脏组织SNR、主动脉SNR差异有统计学意义（P均<0.05）,不同TI门静脉图像分支评分差异无统计学意义（P>0.05）。门静脉高压组不同TI图像的肝内分支评分构成比差异有统计学意义（P=0.012）;选择900 ms TI时,门静脉高压组门静脉主干SNR和CNR、图像评分均低于正常组,TI为1100 ms时,两组图像评分的差异无统计学意义（P>0.05）。结论 对于正常受检者,TI为700 ms时既能得到较好的背景压制的图像,又能保证显示门静脉远端细支血管;而对于门静脉高压患者,选择TI为1100 ms更有利于门静脉分支血管的显示。     

Duplex sonography and colour Doppler in the diagnosis and follow-up of portal vein thrombosis

Clinical findings in acute portal vein thrombosis are often limited and non-specific. Many portal vein thromboses probably remain undiagnosed during the acute stage, and some of these may be discovered later because of complications such as variceal bleeding. Ultrasound with pulsed Doppler and colour Doppler is useful in the diagnosis of the thrombus, and for evaluation of its extension, hemodynamic significance and complications. We present a case of acute portal vein thrombosis associated with protein S deficiency, and review the findings of ultrasound and Doppler in the light of those previously reported. We describe the lack of Doppler signal in the splenic vein and inability to visualize the portal vein and its intra-hepatic branches as one normally can. Further observations include a thrombosed portal vein branch within the liver, prominent branches of the hepatic artery, splenomegaly, partial recanalization and development of collaterals. In the hepatic veins, we found pathologic blood flow with reduced heart-synchronous variations of velocity, as often found in portal hypertension due to cirrhosis. This is not previously reported in portal vein thrombosis, and may be a sign of a portal vein thrombosis with a large degree of obstruction to blood flow and development of portal hypertension. This phenomenon can be explained using hemodynamics.     

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.     

Splenic vein thrombosis

A retrospective review of all admissions to the University of Kentucky Medical Center from 1977 to 1987 revealed six persons in whom splenic vein thrombosis could be documented. The patients had either upper gastrointestinal bleeding from gastroesophageal varices or abdominal pain. Pancreatic disease was present in five patients (83%), three (50%) had splenic enlargement, and five (83%) had normal results of liver function tests. Angiography showed an occluded splenic vein with collateral flow and a patent portal vein in each of the four patients studied. All patients had splenectomy, with or without additional procedures. After a mean follow-up period of 9 1/2 months, five patients (83%) were alive, and none has had further gastrointestinal bleeding. One patient had died of recurrent pancreatic carcinoma at nine months. Our data suggest that localized portal hypertension induced by splenic vein thrombosis is appropriately treated by splenectomy.     

Portal vein thrombosis and liver disease.

Portal vein thrombosis can occur secondary to infection, surgical intervention, or as a result of liver dysfunction. Its development can precipitate the need for emergency interventions including endoscopy, transjugular intrahepatic portosystemic stents (TIPS), portacaval shunts, or even liver transplantation. Portal vein thrombosis occurs slowly and silently. Portal vein thrombosis is not discovered until gastrointestinal hemorrhage develops in the patient unless the thrombosis is diagnosed on routine surveillance diagnostic testing. Portal vein thrombosis can be diagnosed by Doppler ultrasonography, computed tomography scan, or magnetic resonance imaging. Late identification of portal vein thrombosis can lead to increased morbidity and mortality of the patient population. Patients with portal vein thrombosis can be successfully managed with early identification and collaboration between the patient and the health care team for ongoing monitoring and treatment. Patient education involves assisting the patient in the understanding of esophageal varices, the various treatment modalities, their physical limitations, and the need for monitoring and management of the portal hypertension.     

Intraoperative Contrast‐Enhanced Sonographic Portography Combined With Indigo Carmine Dye Injection for Anatomic Liver Resection in Hepatocellular Carcinoma

We present a method of intraoperative contrast‐enhanced sonographic portography combined with indigo carmine dye injection for anatomic liver resection in hepatocellular carcinoma. During surgery, before dye infusion into the feeding portal vein, the targeted portal vein branch was directly punctured, and a microbubble contrast agent was administered under sonographic guidance. Simultaneous enhancement of the resected hepatic parenchyma with a microbubble contrast agent and blue dye improved estimation of the segmental border in the cutting plane and the tumor resection margin during liver surgery.     

二维彩色多普勒超声观测肝硬化门脉高压症脾肺固定合并门奇断流术前后门脉系统血流动力学改变

本文应用二维彩色多普勒超声对8例肝硬化门脉高压症的门脉系统血流动力学在脾肺固定合并门奇断流术前后分别进行定量研究和对比分析。结果表明术后门静脉及睥静脉的内径、平均流速和血流量比术前明显缩小和降低(P<0.001～0.05),门、睥静脉的血流量减少,两者呈正向相关关系(r=0.93,p<0.001)。结果认为该手术能使门静脉系统发生断流、分流和减流.使门静脉系统血流量减少,门脉高压及脾胃区高压缓解。双功能超声对门脉高压症手术方法的选择及效果的评价是一种有临床应用价值的无创性检查方法。     

肝硬化门静脉高压门脉血流动力学检测及其临床意义

目的：探讨肝硬化门脉高压患者门脉血流动力学状态并分析其与Child-Pugh肝功能分级的关系。方法：利用多普勒超声技术检测了100例肝硬化门脉高压患者及24例正常人门脉血流动力学状态,并将100例肝硬化门脉高压患者按Child-Pugh肝功能分级分析两者之间的关系。结果：肝硬化门脉高压门脉血流动力学检查与正常对照组比较、门脉高压组门静脉（PV）内径明显增宽、血流速明显减慢、血流量参数明显增加,差异有显著性意义（P＜0．01）;脾静脉（SV）肠系膜上静脉（SMV）内径（D）、血流速度（V）、血流量参数（Q）也有类似改变。A、B、C三级肝硬化的PV内径,按A、B、C顺序显示门静脉宽度逐渐增宽,C级的Dpv较A、B级均有显著性增宽（P＜0．05）,A、B级间差异无显著性意义（P＞0．05）,但B级较A级也有增宽趋势,按A、B、C顺序显示 门静脉血流速度逐渐降低,且各级间比较差异有显著性意义（P＜0．05）。A、B、C级的Qpv相互比较无统计学差异（P＞0．05）。结论多普勒超声检测门脉血流动力学有助于评价肝硬化患者的肝储备功能、门静脉高压程度及预后。     

Pancreatic neuroendocrine carcinoma in a pregnant woman: A case report and review of the literature

BACKGROUNDPortal venous thromboembolism caused by malignant pancreatic neuroendocrine tumor metastasis, as the initial presentation of portal hypertension and upper gastrointestinal bleeding, is a rare entity. To our knowledge, there are no reports of this entity in pregnant women. We describe a case of pancreatic neuroendocrine carcinoma during pregnancy with hematemesis and hematochezia as the initial presentation and review the literature to analyze the demographic, clinical, and pathological features to provide a reference for clinical diagnosis and treatment.CASE SUMMARYA 40-year-old woman presented with hematemesis and hematochezia at 26-wk gestation; she had no other remarkable medical history. The physical examination revealed normal vital signs, an anemic appearance, and lower abdominal distension. Abdominal color Doppler ultrasonography showed portal vein thrombosis, splenomegaly, intrauterine pregnancy, and intrauterine fetal death. Esophagogastroduodenoscopy revealed esophageal and gastric varicose veins and portal hypertensive gastropathy. Contrast-enhanced computed tomography demonstrated multiple emboli formation in the portal and splenic veins, multiple round shadows in the liver with a slightly lower density, portal vein broadening, varicose veins in the lower esophagus and gastric fundus, splenomegaly, bilateral pleural effusion, ascites and pelvic effusion, broadening of the common bile duct, and increased uterine volume. According to the results of Positron emission tomography-computed tomography and immunohistochemical staining, the final diagnoses were that the primary lesion was a pancreatic neuroendocrine tumor and that there were secondary intrahepatic metastases and venous cancer thrombogenesis.CONCLUSIONUpper gastrointestinal bleeding in a pregnant woman may be caused by portal hypertension due to a malignant pancreatic neuroendocrine tumor.     

Anatomic variation of portal venous anatomy in the porta hepatis: ultrasonographic evaluation.

The appearance of the portal vein as it crosses anterior to the inferior vena cava and enters the liver at the porta hepatis was evaluated on 100 longitudinal and 100 transverse ultrasonograms. Three major variations were noted on the parasagittal scans, while four major variations were evident on the transverse images. These variations were primarily related to the size of the left portal vein and the angle at which the left portal vein coursed away from the main portal vein. The appearance and course of the proximal right portal vein was extremely constant and may therefore be used as a landmark to detect pathologic processes in the porta hepatis. Detection of altered anatomy in this region may be especially helpful in correctly differentiating dilated intrahepatic bile ducts from normal portal veins.