彩色多普勒超声对肝炎后肝硬化脾肿大脾内血流的研究

目的　应用彩色多普勒检测脾内动、静脉血流参数 ,为肝硬化门静脉高压症的诊断与治疗提供依据。方法　肝硬化患者和正常对照组各 81例 ,检测脾动、静脉及其脾内分支。结果　正常对照组脾动脉及其脾内分支越接近末梢血流阻力指数越低 ,而肝硬化各组结果与其相反。肝硬化各组脾充血指数与正常对照组相比较有极显著性差异。结论　应用彩色多普勒检测脾动、静脉及其脾内分支血流参数对肝硬化门静脉高压症的诊断与治疗有重要的临床意义     

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.     

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.     

超声评价正常小儿肝脏血管的内径及血流动力学

目的 通过超声检查获取正常小儿肝脏血管的内径及血流动力学参数测值.方法 对213名正常小儿进行二维及多普勒超声检查,测量肝动脉的内径及阻力指数(RI)、搏动指数(PI),门静脉主干及分支的内径、血流速度、血流量.测量数据进行相邻年龄组间比较.结果 肝动脉的内径随着年龄的增长而增加且相邻组间差异有统计学意义,R1和PI则是相对较恒定的参数.门静脉主干及分支的内径及血流量随着年龄的增长而递增,但增幅减小,幼儿期增长最明显.门静脉主干及分支的血流速呈现随年龄增长增高后有回落的趋势.结论 小儿肝脏血管的内径及血流动力学随其生长发育也在不断变化,其增长的特点与小儿生长发育特点相吻合.     

彩色多普勒超声对肝移植术后并发症的诊断价值

目的评价彩色多普勒超声对肝移植术后并发症的诊断价值。方法回顾性分析和总结26例肝移植术后并发症的彩色多普勒超声检查资料,检测指标包括肝动脉及左右分支的峰值速度（HAPV）、阻力指数（RI）、加速度及加速时间,门静脉平均流速,肝实质及胆管回声。结果6例经手术或造影证实为血管并发症（肝动脉血栓形成1例,肝动脉狭窄2例,肝动脉痉挛1例,门静脉狭窄2例）,彩色多普勒超声表现有肝动脉狭窄处的高速高阻血流并伴有湍流,而狭窄远端峰值速度〈40cm／s,RI〈0．5,加速时间〉0．08s,加速度〈300cm／s^2,1例肝动脉血栓形成肝门部无动脉血流信号;6例急性排斥反应,3例胆管结石并扩张。结论彩色多普勒超声对肝移植术后血管并发症的诊断具有重要的指导意义。     

彩色多普勒超声对门脉高压食管静脉曲张出血的诊断价值

目的评价门脉血流动力学参数在预测肝硬化食管静脉曲张高危患者中的作用。方法对85例肝硬化患者行胃镜和彩色多普勒超声检查,使用单因素分析和多元分析对门脉血流动力学指标与确认的食管静脉曲张的存在和规模间的关系进行评估。结果食管静脉曲张组的肝动脉阻力指数、脾动脉阻力指数、充血指数、门脉高压指数较无食管静脉曲张组大,肝血管指数较无食管静脉曲张组小,食管静脉曲张重度组的肝动脉阻力指数、脾动脉阻力指数、脾脏长径、充血指数、门脉高压指数较轻-中度组大,肝血管指数较轻-中度组小,差异均有统计学意义（P〈0．05）。结论彩色多普勒超声对门脉高压食管静脉曲张出血有较高的诊断价值。     

内镜套扎联合部分脾栓塞术治疗门脉高压症及其对血流动力学的影响

目的 :探讨一种新的治疗门脉高压症的手术方法。方法 :对 41例合并食管静脉曲张和脾功能亢进的门脉高压症患者实施内镜套扎 -部分脾栓塞联合治疗 ,手术前后采用彩色多普勒超声检查门奇静脉侧支循环情况 ,与对照组进行对比研究。结果 :除 1例患者出现异位栓塞死亡 ,1例出现脾脓肿经开腹手术治疗得到治愈外 ,未发生其他严重并发症。联合术后患者食管曲张静脉得到根治 ,脾功能亢进缓解。手术后患者门静脉血流速度减慢 ,血流量减少 (P <0 .0 5) ,奇静脉血流量降低 (P <0 .0 1 ) ,胃左静脉血流速度减慢 (P <0 .0 5)。术后随访 2～ 2 4个月 ,未出现复发性出血。结论 :联合术能有效地治疗门脉高压症食管静脉曲张出血和脾功能亢进 ,减少了闭塞曲张静脉所需重复套扎次数及近期再出血 ,同时术后减少了门静脉血流速度 ,血流量 ,降低了套扎术后复发出血的风险 ,该方法操作简单 ,侵袭性小 ,尤其适应于肝功能较差 ,难以耐受分流及断流手术的门脉高压症患者。     

彩色多普勒超声检测移植肝血流变化预测胆道并发症发生的可行性

目的探讨肝移植术后彩色多普勒超声检测血流变化预测胆道发生并发症的可行性。 方法超声观察125例肝移植患者术后肝脏动静脉血流变化，主要观测血管内径（D），峰值流速（PS），阻力指数（RI），时间平均流速（TAV）。 结果肝移植术后，发生胆道并发症者49例，各项指标分别与术后未发现并发症的对照组59例相比：（1）术后30d内肝动脉PS减低，RI增高，2项指标差异均有显著性意义；（2）术后15d内并发症组肝静脉D较细，TAV减低，差异均有显著性意义；（3）两组间门静脉TAV差异无显著性意义，但并发症组中，单纯肝动脉供血不足者13例，门静脉TAV增高，与对照组相比，差异有非常显著性意义；单纯出现排异反应者8例，门静脉TAV减低，与对照组相比，差异有显著性意义。 结论超声预测肝移植术后肝动脉供血不足及排异反应导致的胆道并发症是可行的。     

慢性肝炎超声血流成像定量指标与肝功能损害程度的相关性研究

目的 探讨慢性肝炎门静脉及肝动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 将457例慢性肝炎患者肝功能异常分为轻度组、中度组和重度组,选取120例健康者为对照组;全部受检者均行门静脉、肝动脉超声检测和血清学、病毒标记物检测,209例患者经肝组织活检病理证实.将超声测值与血清学检测的肝损害程度分期对照分析.结果 对照组与轻度组,在门静脉内径、门静脉血流速度比较,无显著差异(P＞0.05);在肝动脉流速、阻力指数和收缩期峰值与舒张期峰值比值中存在显著差异(P＜0.05);对照组、轻度组与中度组、重度组在血流定量指标中存在显著差异(P＜0.05).结论 慢性肝炎患者门静脉流速、肝动脉流速及肝动脉阻力指数等能反映肝脏肝功能损害程度,从而对慢性肝病的临床治疗评价有一定的价值.     

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。     

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.     

超声检测门脉高压患者肝脾动脉阻抗指数与门脉压力相关性研究

目的探讨肝动脉、脾动脉阻力指数（HARI、SpARI）及门脉高压指数（PHI）在评价门脉高压中的应用价值。方法57例临床确诊门脉高压并行门奇断流或脾肾分流术的患者被纳为门脉高压组,对照组为25例健康志愿者。门脉高压组均在术前1d行超声检查,对照组在空腹8h以上行超声检查。采用频谱多普勒检测门静脉平均血流速度（PVVel）、HARI、SpARI及肝脾动脉搏动指数（HAPI、SpARI）,并计算门脉高压指数（PHI）。门脉高压组门脉压力以术中胃网膜右静脉直接测压为准。结果对门脉高压组采用直接压力测定法测得门脉压力为（30.090±4.151）mmHg。门脉高压组HAPI、SpAPI及PHI高于正常对照组（P=0.012,P=0.034,P=0.026）,而PVVel、HARI及SpARI在两组之间差异无统计学意义。以HAPI=1.34诊断门脉高压的敏感性为73%、特异性80%、准确性74%。HARI、HAPI与门脉压力呈显著正相关（r=0.699,r=0.582,P均〈0.001）。门脉压力与肝功能Child-Pugh分级呈显著正相关（r=0.589,P=0.044）。结论HAPI在门脉高压组显著高于正常对照组,且与门脉压力呈显著正相关,因此HAPI可作为评价门脉高压的有效指标。     

部分性脾动脉栓塞对肝硬化门静脉高压血流动力学的影响

目的 :探讨部分性脾动脉栓塞术对肝硬化门静脉高压血流动力学的影响。方法 :3 2例肝硬化门静脉高压症患者行部分性脾动脉栓塞治疗 ,在治疗前后 ,应用彩色多普勒超声观察 ,对门静脉 ,脾动、静脉血流动力学变化做定量分析和对比。结果 :部分性脾动脉栓塞术后 4周的门静脉、脾静脉和脾动脉的内径较术前明显缩小 (P <0 .0 1) ,血流量明显减少 (P <0 .0 1) ,血流速度无明显变化 (P >0 .0 5 )。结论 :部分性脾动脉栓塞对肝硬化门静脉高压血流动力学有重要影响 ,可显著降低门静脉压力 ,此对相关症状的改善有重要意义     

肝血管指数在原发性与继发性肝癌鉴别诊断中的应用价值

目的探讨肝血管指数（LVI）在原发性肝癌与继发性肝癌鉴别诊断中的临床意义。方法应用多普勒超声技术分别对42例原发性肝癌和50例继发性肝癌患者的肿瘤供血动脉血流峰值速度（Vmax）、阻力指数（RI）、门静脉Vmax、肝动脉搏动指数（PI）及LVI进行比较分析。结果原发性肝癌组36例（85．71％）门静脉Vmax〈18cm／s，继发性肝癌组门静脉仅2例（4．00％）Vmax〈18cm／s，两组间差异有统计学意义（P〈0．01）；肝动脉PI原发性肝癌组高于继发性肝癌组（P〈0．01）。原发性肝癌患者LVI为（8．06±2．34）cm／s，继发性肝癌患者LVI为（19．07±3．52）cm／s，两者相比差异有统计学意义（P〈0．01）；在原发性肝癌组中40例（95．24％）LVI〈12cm／s，继发性肝癌组46例（92．00％）LVI≥12cm/s，两者相比差异有统计学意义（P〈0．01）。LVI与肝癌结节大小、数量无相关性，与肝癌病理类型密切相关。LVI对原发性肝癌诊断的敏感性为95．24％、特异性92．00％、准确性93．48％、阳性预期值90．91％、阴性预期值95．83％。结论LVI是原发性肝癌与继发性肝癌鉴别诊断的一个有效参数。     

超声检查进餐前后肝脏血供改变及其意义

目的探寻进餐前后肝脏血流的超声扫查指标及其意义。方法超声对比检测正常肝与弥漫性肝病进餐前后门静脉和右肝动脉血流改变。结果进餐前后门脉内径、流速和流量，肝动脉阻力指数等正常组与异常组存在明显差异。结论餐后异常组的门静脉内径、流量，肝动脉阻力指数等指标与正常组的差异，可能对理解肝血供异常有参考意义。     

Hemodynamic features of Doppler ultrasonography in patients with portal hypertension: intraoperative direct measurement of portal pressure in the portal venous system.

OBJECTIVE: The purpose of this study was to investigate the relationship between a series of portal hemodynamic parameters obtained with Doppler ultrasonography and portal pressure measured directly from patients with portal hypertension (PHT). METHODS: Fifty-seven patients with a clinical diagnosis of PHT who accepted surgical therapy were investigated. The portal pressure was measured directly intraoperatively. Relevant parameters were compared and measured, including the hepatic artery pulsatility index (HAPI), hepatic artery resistive index (HARI), splenic artery resistive index, splenic artery pulsatility index (SpAPI), congestion index (CI) of the portal vein, hepatic buffer index (HBI), liver vascular index (LVI), and PHT index (PHI). RESULTS: Doppler parameters for the postprandial HAPI, SpAPI, CI, LVI, HBI, and PHI were statistically different in patients with PHT and healthy control subjects (P<0.05). The portal pressure was significantly correlated with the HARI (r=0.699; P<.001), HAPI (r=0.582; P<.001), LVI (r=-0.501; P=.003), HBI (r=0.441; P=.009), and Child-Pugh scores (r=0.589; P=.044). CONCLUSIONS: The HAPI, LVI, and HBI are indicative indices in patients with PHT, suggesting that color Doppler ultrasonography can be used as a noninvasive evaluation method for PHT degree. The changes in the HAPI, LVI, and HBI that accompany the increase in portal pressure can reflect hepatic resistance and hepatic artery buffer capacity accurately.     

彩色多普勒血流显像检测移植肝血流参数变化对于评估移植肝及对并发症早期诊断的价值

目的利用彩色多普勒血流显像（CDFI）检测移植肝血流动力学参数变化，评估移植肝状况及对其并发症早期诊断的价值。 方法利用CDFI检测75例原位肝移植者不同时期肝动、静脉及门静脉峰值血流速度（PS）、时间平均血流速度（TAV）、阻力指数（RI）、肝动脉血流灌注指数（DPI），并与30例正常人进行对照；利用静脉超声造影检测7例肝移植者造影声像图。 结果（1）移植术后23例无明显并发症者血流动力学基本变化是15d内门静脉TAV明显高于正常对照组（P〈0．05）；术后肝动脉PS、DPI7d之内显著低于7d之后（P〈0．05），RI在7d之内显著高于7d之后（P〈0．05）；（2）肝动脉血栓形成时，肝动脉PS明显降低直至消失，门静脉TAV明显增高呈锯齿波，DPI明显降低；（3）排异反应时，门静脉TAV降低、肝动脉PS降低、RI增高、肝静脉三相波消失呈锯齿波或类门静脉平稳波等；（4）移植肝DPI降低时，移植肝胆道并发症容易发生；（5）超声造影显示7例肝移植术后5例肝癌复发者显示动脉期快速增强，门脉期及实质相呈相对低回声。 结论CDFI检测移植肝脏门静脉、肝动脉及肝静脉血流动力学参数变化可以用来评估正常及有并发症的移植肝脏。     

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.     

Spontaneous rupture of intrahepatic artery aneurysm with complicated vascular anomalies

An 18-year-old man developed a sudden onset of upper abdominal pain with vomiting. Ul-trasound and computed tomographic (CT) scans revealed the spontaneous rupture of an intrahepatic artery aneurysm with subcapsular hematoma. A celiac arteriogram demonstrated a ruptured intrahepatic artery aneurysm in the right lobe of the liver, right extrahepatic artery aneurysm, obliteration of gastroduodenal artery, and abnormal flow pattern of the splenic artery. Portal vein phase, using superior mesenteric arteriography, showed portal vein varices and obliteration of the portal trunk. A right hepatic lobectomy was performed. The cut surface of the resected liver revealed a ruptured intrahepatic artery aneurysm with massive hematoma.     

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。