Budd-Chiari综合征的超声诊断

目的 探讨Budd Chiari综合征(B-CS)的特征性异常血管形态及其血流的变化.方法 对85例B-CS患者的肝静脉、下腔静脉,进行彩色多普勒超声分析.结果 85例B-CS其下腔静脉狭窄52例,闭塞9例,肝静脉狭窄102支,闭塞61支,其肝静脉间均见多条侧支血管;肝静脉血流经侧支血管流入未闭的肝静脉或经肝尾叶静脉及其他扩张的静脉分流入下腔静脉;下腔静脉闭塞时血流亦可逆向分流入肝静脉.结论 肝静脉、下腔静脉狭窄和闭塞及肝静脉间侧支血管形成是B-CS特征性异常血管形态;彩色多普勒超声可依据其特征性异常血管的病变类型、阻塞部位、梗阻程度和范围、侧支循环径路及血流动力学特点准确诊断B-CS,并作为首选检查方法.     

彩色多普勒超声在Budd—Chiari综合征的诊断价值

目的:探讨Budd-chiari综合征(B-CS)的特征性异常血管形态及其血流的变化。方法:对85例B-CS患者的肝静脉、下腔静脉。进行彩色多普勒超声分析。结果:85例B-CS其下腔静脉狭窄52例,闭塞9例;肝静脉狭窄102支,闭塞61支,其肝静脉间均见多条侧支血管;肝静脉血流经侧支血管流入未闭的肝静脉或经肝尾叶静脉及其他扩张的静脉分流入下腔静脉;下腔静脉闭塞时血流亦可逆向分流入肝静脉。结论:肝静脉、下腔静脉狭窄和闭塞及肝静脉间侧支血管形成是B—CS特征性异常血管形态;彩色多普勒超声可依据其特征性异常血管的病变类型、阻塞部位、梗阻程度和范围、侧支循环径路及血流动力学特点准确诊断B-CS。并作为首选检查方法。     

彩色多普勒超声在布-加综合征诊断及分型中的价值

目的:探讨彩色多普勒超声在布-加综合征(BCS)诊断及分型中的应用价值。方法:51例经下腔静脉造影或手术证实的BCS患者,分析其彩色多普勒超声直接和间接征象,并根据肝段下腔静脉和(或)肝静脉的阻塞情况进行分型。结果:51例BCS中,下腔静脉型22例,肝静脉型9例,混合型16例,漏诊4例,超声诊断符合率92.2%(47/51),超声分型与血管造影或手术诊断一致。直接征象表现为肝静脉和(或)下腔静脉隔膜或纤维性狭窄、闭塞或栓塞;而肝尾叶增大、肝内交通支和下腔静脉侧支是重要的间接征象。超声漏诊4例均为下腔静脉型,与诊断意识不足和超声成像的局限性有关。结论:彩色多普勒超声有助于明确布-加综合征诊断和分型,可作为临床首选的检查方法。     

布-加综合征的彩超诊断

目的:探讨2000～2011年用彩色多普勒超声(彩超)检查对Budd-Chiari Syndronme,BCS(布-加综合征)的诊断.方法:均行彩色多普勒超声检查.结果:19例患者中肝癌继发肝静脉、下腔静脉癌栓13例;下腔静脉狭窄2例;下腔静脉瘤样扩张后狭窄1例;肝炎肝硬化继发肝癌、下腔静脉癌栓2例;右肺肿瘤下腔静脉受压1例.结论:旨在探讨布加综合征的彩超表现,使基层医生增加对此病的认识,以免误、漏诊.     

布加综合征彩色多普勒血流显像检查结果及影像学特点

目的分析布加综合征患者彩色多普勒血流显像(CDFI)检查结果及影像学特点。方法选取开封市第二人民医院2015年1月至2017年12月收治的45例布加综合征患者为研究对象,均进行CDFI检查,分析CDFI检查结果及患者影像学表现特点。结果经CDFI检查,布加综合征阳性检出率为91.11%(41/45),其中9例为肝静脉阻塞,32例为下腔静脉阻塞。肝静脉阻塞患者表现为血管腔狭窄性显影,血管内血流信号紊乱。肝后段下腔静脉狭窄患者表现为肝右后叶不均匀回声团,回声团内含有动脉血流频谱,周边存在声晕;下腔静脉膜性阻塞患者表现为血管壁厚度不均,存在扩增及反向血流;下腔静脉栓塞患者表现为血管管腔明显变窄,肝段下腔静脉含有实质性回声团;下腔静脉节段性狭窄患者表现为管壁增厚,管腔狭窄。结论 CDFI检查可清晰显示布加综合征患者肝静脉或肝段下腔静脉狭窄或闭塞情况、血管病变及血流动力学情况,阳性检出率高,可为临床诊断布加综合征提供参考依据。     

彩色多普勒超声在布加氏综合征诊断中的应用

目的 探讨彩色多普勒血流显像(CDFI)对布加氏综合征(BCS)的诊断价值.方法 应用彩色多普勒超声对35例BCS的超声表现及诊断结果进行分析,将BCS分为3型:单纯肝静脉阻塞型、下腔静脉阻塞型和混合型.结果 单纯肝静脉阻塞型4例,下腔静脉阻塞型18例,混合型10例,误诊为肝硬化3例,诊断准确率为91.4%.结论 彩色多普勒超声能够显示布加氏综合征的血管阻塞部位、程度、范围及侧支循环,可作为布加氏综合征的首选诊断方法.     

彩色多普勒血流显像在诊断布加综合征中的临床应用

目的 前瞻性探讨彩色多普勒血流显像(CDFI)在诊断布加综合征(BCS)中的临床应用价值.方法 经造影证实BCS患者19例,将其术前1周内的CDFI检查结果与造影结果进行对照研究,观察和总结CDFI诊断BCS的表现及特征.结果 经造影证实的19例BCS中,单纯肝静脉阻塞7例,肝静脉和下腔静脉同时阻塞12例,CDFI正确诊断19例,诊断符合率为100%.结论 CDFI诊断BCS准确率较高,将成为诊断BCS重要的无创伤性检查方法.     

彩色多普勒超声在评价布-加综合征治疗前后的应用

目的通过对布-加综合征(Budd-Chiari syndrome,B-CS)患者治疗前后的超声观察,评价彩色多普勒超声在B-CS的应用价值。方法对22例确诊为B-CS的患者进行术前彩色多普勒超声检查,并对此22名患者进行术后再次行超声检查。结果 B-CS在彩色多普勒超声上的典型特征是下腔静脉狭窄或闭塞;肝静脉狭窄及闭塞;肝内交通支形成。治疗后其以上表现均出现不同程度的改善。结论彩色多普勒超声为诊断B-CS提供了有效手段,且对选择合理治疗方案及评价治疗效果具有指导意义。     

三维动态增强MRA与SCTA在Budd-Chiari综合征诊断中的价值

目的　评价三维动态增强磁共振血管成像 (3DDCEMRA)和螺旋CT血管成像(SCTA)对Budd -Chiari综合征 (BCS)的诊断价值。方法　回顾分析 7例BCS的 3DDCEMRA和SCTA影像资料 ,以手术病理或下腔静脉造影结果为标准 ,评价 2种血管成像技术对BCS下腔静脉、肝静脉、门静脉的病变部位、程度以及肝内外侧枝循环的显示情况。结果　 4例 3DDCEMRA检查中显示 :下腔静脉狭窄 3例 ,闭塞 1例 ;肝静脉狭窄 3例 ,闭塞 1例 ;副肝静脉增粗 1例 ,肝内外侧枝循环形成 2例。 3例SCTA检查中显示 :下腔静脉狭窄 1例 ,闭塞 1例 ;肝静脉闭塞 1例 ,副肝静脉增粗 2例。结论　 3DDCEMRA和SCTA对Budd -Chiari综合征有很高的诊断价值 ,是术前全面评价BCS的 2种有效的无创性血管成像技术     

彩色多普勒观察Budd-Chiari综合征肝静脉病变及其血流动力学变化

目的 :探讨 Budd- Chiari综合征 (B- CS)肝静脉改变及其血流动力学变化。方法 :对 9例经 X线血管造影证实的B- CS患者肝静脉的二维超声及彩色多普勒检查结果进行分析。结果 :肝静脉隔膜型狭窄、闭塞 3例 ,血栓所致阻塞 1例 ,肝静脉节段性狭窄 2例 ,外压所致狭窄 1例。狭窄或闭塞的肝静脉血流经侧支循环分流至未闭的肝静脉或经肝尾叶静脉汇入下腔静脉。合并下腔静脉闭塞者 ,肝静脉血流通过门脉及腹膜后静脉丛等汇入上腔静脉。结论 :彩色多普勒观测 B- CS肝静脉病变部位、程度及其血流动力学改变 ,对诊断及治疗方案的选择具有重要意义     

Budd-Chiari综合征术前诊断与术后疗效评估

目的探讨彩色多普勒超声(CDFI)在巴德-吉亚利综合征的术前诊断和术后随访中的应用价值,为临床诊治提供可靠依据。方法 26例巴德-吉亚利综合征患者在术前及术后应用彩色多普勒超声检查进行诊断分析。重点检查患者的下腔静脉(IVC)、肝静脉(HV)及门脉系统,记录相应血管直径、管腔内回声、狭窄及闭塞的部位、形态、长度范围,注意彩色血流充盈状况及频谱多普勒形态。结果 26例患者中肝静脉阻塞9例,肝段下腔静脉阻塞17例,同时合并两者病变6例。全部经下腔静脉血管造影及手术确诊。24例患者术后彩色多普勒检查示血流通畅,临床疗效满意。结论彩色多普勒超声可在术前明确判断巴德-吉亚利综合征的血管阻塞部位、程度、范围及侧支循环,并可指导临床治疗和评价手术后效果。     

布-加综合征和肝内型门静脉高压症患者血流动力学比较

目的:探讨布-加综合征(Budd-Chiarisyndrome,B-CS)及肝内型门静脉高压症(portalhypertension,PHT)患者血流动力学变化之间的差异。方法:利用彩色多普勒超声对40例B-CS患者、24例PHT患者和24名正常人的门静脉(PV)内径和平均血流速度、每min血流量(Q)进行测算,同时观察肝静脉(HV)、下腔静脉(IVC)变化和肝内侧支血管的形成情况等。以24例健康者为正常对照。结果:B-CS组及PHT组PV内径均大于正常对照组(P均<0.05),PV平均血流速度和Q均小于正常对照组(P均<0.05)。B-CS组上述3指标均小于PHT组(P均<0.05)。B-CS组患者HV病变38例(95%),表现为开口闭塞或狭窄,远端扩张、迂曲等;PHT组发现HV轻度受压狭窄10例(41.7%),HV显示不清3例(12.5%);正常对照组HV均显示正常。IVC病变24例(60%),主要表现为IVC膜性阻塞、狭窄、闭塞,阻塞下方有血栓和IVC扩张,IVC壁搏动消失,血流速度加快、呈双向和逆流等;PHT组发现IVC轻度狭窄8例(33.3%),余正常;正常对照组IVC显示正常。B-CS组特征性的肝内侧支血管形成,表现为HV之间的交通支开放,副肝静脉扩张等;PHT组和正常对照组未发现肝内侧支。结论:B-CS涉及多支HV、PV和IVC系统,患者存在复杂的血流动力学变化。肝内侧支出现是B-CS区别于PHT的特征性表现。     

Preliminary evaluation of magnetic resonance fresh blood imaging for diagnosis of Budd-Chiari syndrome

Background Budd-Chiari syndrome （BCS） is a rare disease with portal hypertension caused by the blockage of the hepatic vein and/or the inferior vena cava （IVC）. Angiography is the ＂golden standard＂ for diagnosis, but it is an invasive examination. To assess the diagnostic value of a fresh blood imaging （FBI） relative to BCS, we used a magnetic resonance angiography （MRA） with an FBI sequence for a preoperative evaluation of the BCS patients in this study. Methods Fifty patients who were suspected of having BCS after they had been checked by a B-ultrasound were studied. 2D and 3D FBI were performed on a 1.5T superconductive MR scanner. Original images were rebuilt using a maximal intensity projection （MIP） method on the console. Two doctors reviewed all images before they learned of the angiography results. We then compared the diagnoses obtained from the FBI and angiography results to evaluate the diagnostic value of the FBI. Results Forty-one patients were diagnosed as BCS and 9 as non-BCS based on an angiography. The FBI correctly diagnosed 38 patients, incorrectly diagnosed 1 patient, and missed diagnosis in 3 patients. Thus, the diagnostic sensitivity of the FBI is 93% （38/41）, the specificity is 89% （8/9） and the accuracy is 92% （46/50）. The FBI images of the 13 membranous stenoses of the IVC showed a sudden stenosis of the post-liver segment of the IVC. The Images of the 5 patients with a membranous obstruction of the IVC showed IVC thickening and an absence of blood signals in the post-hepatic segment of the IVC. The images of the 4 patients with the segmental thrombosis of the IVC showed abnormal and intermittent signals in the IVC. The images of the 6 patients with a simple hepatic vein obstruction showed obstructive hepatic veins. The images of the 6 patients with the stenosis of both the IVC and the hepatic veins showed the stenosis of the IVC, the thickening of the hepatic veins and the formation of a compensatory circulation within the liver. Lastly, the images of the 7 patients showed a combination of the IVC thrombosis with stenosis or with the obstruction of one or two hepatic veins. Conclusions An FBI can show a membranous stenosis, and an obstruction and thrombosis of the IVC. In addition, it can also demonstrate the thickening of the flexural hepatic vein and the development of intra-hepatic compensatory branches with slow blood flow. Thus, it can guide the puncturing and opening of the hepatic vein involved in an interventional therapy for BCS patients.     

原位肝移植术后血管并发症的超声诊断价值

目的评价彩色多普勒血流显像（color Doppler Flow Imaging,CDFI）技术对原位肝移植（Orthotopic Liver Transplantation,OLT）术后血管并发症的诊断价值。方法732例肝移植受者术后常规进行CDFI血流监测,对可疑血管并发症患者进行血管造影、螺旋CT及手术探查。结果CDFI检测出血管并发症61例,经血管造影、螺旋CT或手术确诊血管并发症53例,包括：肝动脉狭窄14例,肝动脉栓塞12例,肝动脉假性动脉瘤4例,门静脉狭窄12例,门静脉栓塞8例,流出道梗阻3例。结论彩色多普勒血流显像技术在肝移植后血管并发症的诊断中具有重要作用。     

布-加综合征介入治疗术后血流动力学变化的评估

目的 探讨布-加综合征(BCS)介入治疗后形态学及血流动力学变化的特点。方法 应用二维超声及彩色多普勒血流显像检测30例正常人和256例BCS患者介入治疗前后下腔静脉及肝脾形态及血流动力学参数。结果 ①形态学变化:与对照组相比,患者介入治疗前,肝脾增大(P<0.005),肝尾状叶增大尤其明显(P<0.001);介入治疗后,治疗1周时肝脾较治疗前减小(P<0.005),与对照组相比脾脏仍较大(P<0.005);介入治疗后6月脾脏仍大于对照组(P<0.005)。②血流动力学变化:与对照组相比,下腔静脉狭窄者可见局部高速血流,阻塞者局部无血流信号,肝静脉扩张,血流减慢,并可见肝内侧枝血管,门静脉入肝血流速度减慢;介入治疗后,下腔静脉病变处增宽(P<0.005),血流恢复,并可见支架回声,肝静脉及门静脉血流速度加快(P<0.005)。结论 介入治疗解除了BCS患者肝脏血液回流受阻,改善了其血流动力学状态。     

Budd-Chiari综合征的介入治疗

目的: 总结病变段球囊扩张及内置支架治疗布-加综合征(Budd-Chiarisyndrome,BCS)的经验。方法: 对359例BCS患者行下腔静脉(IVC)或经皮肝穿肝静脉(HV)造影,确定病变部位、类型,再用导丝硬头或破膜针穿通阻塞部位、球囊扩张、内置支架。结果: 破膜扩张成功318例,其中IVC306例,HV12例。放置IVC支架232例,HV支架2例,无肺栓塞发生。术后肝昏迷1例,急性心功能不全21例。并发IVC急性血栓形成2例。248例获随访6~126个月,复发21例。结论: 介入治疗BCS微创、安全、有效,术后并发症少,恢复快,为首选治疗方法。     

布-加综合征手术前后血流动力学变化的临床研究

目的探讨布-加综合征（Budd-Chiari syndrome,B-CS）手术前后血流动力学变化规律。方法应用彩色超声多普勒对76例B—CS患者肝静脉变化情况、手术前后下腔静脉和门静脉主干内经或血流量进行了检测,同时在求中测量了下腔静脉压力和自由门静脉压力（free portal pressure,FPP）的变化。结果1a型21例,1b型6例,Ⅱ型23例,Ⅲa型17例,Ⅲb型9例。62例主肝静脉病变,副肝静脉（肝右后下静脉等）和（或）尾叶静脉扩张30例,肝内出现肝静脉交通支47例。肝后段下腔静脉病变53例。介入治疗23倒,根治性病变隔膜切除＋血栓取出术5例,下腔静脉转流术16例（包括腔-腔和腔-房人工血管架桥术）,门腔分流术28例（肠-腔、脾-腔和脾-房人工血管架桥术）,脾-肺固定术4例。介入和下腔静脉转流术后下腔静脉内径变窄和压力明显下降（P均〈0.05）;分流术后FPP降低（P〈0.05）。术后门静脉主干内径缩小（p〈0.05）,平均流量和术前相比无明显变化（P〉0.05）。术中开放人工血管后短时间内（30分钟）可见肝脏从边缘开始质地变软,颜色由暗转红。近期随访（出院前）下腔静脉通畅,其远端扩张缓解,人工血管通畅。16例上消化道出血或食管静脉重度曲张患者进行胃镜复查,12例曲张程度减轻,4例消失。结论B-CS表现有特征性的血流动力学变化,根据其特点结合病变类型,可指导临床进行治疗方法的选择和预测（评估）治疗效果。     

布-加综合征介入治疗术后血流动力学变化的评估

OBJECTIVE: To study the changes in morphology of liver and spleen and hemodynamics of the patients with Budd-Chiari syndrome (BCS) after interventional treatment. METHODS: The dimensions of liver and spleen were detected by routine ultrasonography in 30 normal control subjects and 256 BCS patients before and after inventional therapy. Color duplex sonography was employed to measure the hemodynamic changes. RESULTS: Compared with the control group, BCS patients before interventional therapy showed obvious liver and spleen enlargements (P<0.005), specially the caudate lobe of the liver (P<0.001), which were significantly reduced 7 days after interventional treatment (P<0.005), but the spleen was still larger than that of the control group (P<0.005) even till 6 months after the therapy. Color Doppler flow imaging (CDFI) revealed local high-speed blood flow in patients with stenosis of the inferior vena cave (IVC), but color flow was not detected in patients with IVC obstruction, who had hepatic vein dilation (P<0.005) with slowed blood flow and collateral formation of in the liver, as well as decreased velocity of blood flow in the portal vein. After interventional treatment, the diameter of the involved IVC increased with blood flow restoration and the size and shape of the stent were detected clearly. The velocity of blood flow was increased in both the hepatic and portal veins (P<0.005). CONCLUSION: Interventional therapy can relieve obstruction of blood flow in the liver and improve the hemodynamics of patients with BCS.     

Endovascular treatment of Budd-Chiari syndrome

Background  Budd-Chiari syndrome (BCS) is a posthepatic portal hypertension caused by the obstruction of the lumen of the hepatic veins or the proximal inferior vena cava (IVC). This study aimed to evaluate the clinical experience of interventional therapy for Budd-Chiari syndrome.

Methods  IVC venography was carried out first, the obliteration or stenosis in the IVC was opened or dilated with the hard guided wire or Rups100 puncture needle and balloon, then a stent was routinely implanted for the type of obliteration or stenosis.

Results  The procedure was successful in 821 out of 903 cases including IVC intervention in 760 cases, and hepatic vein intervention in 61 cases. An IVC stent was used in 517 cases and hepatic vein stent in 19 cases. There were no pulmonary embolisms, but acute renal failure occurred in eight cases, hepatic coma in two cases and acute heart failure in 43 cases. Two patients died in this group and five cases were complicated with acute IVC thrombosis. Follow up of 7 to 124 months was made in 679 cases with recurrence found in 59 cases.

Conclusions 　Interventional therapy is safe and effective with a fast recovery for most types of BCS. It is gradually becoming the first therapeutic choice.