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彩色多普勒超声对下腔静脉内支架置入术的评价 总被引:1,自引:0,他引:1
近年来,血管内支架(EMS)置入术作为一种安全有效的非手术方法治疗Budd-Chiari综合征(BCS)已被公认,但往往由于术前缺乏全面准确的检测,致使部分病人术后临床效果欠满意。现就我们检测的12例下腔静脉(IVC)EMS置入者,置入后的彩色多普勒显象及临床治疗效果,总结如下。1资料和方法1.1一般资料本组BCS病人共12例。男9例,女3例。年龄27~63岁,平均42岁。节段性IVC狭窄6例,IVC狭窄合并肝静脉(HV)阻塞2例,IVC膜型阻塞4例。节段性狭窄段长2.5~6.0cm,膜型膜厚0.3~2.1cm。观察时间为… 相似文献
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布-加综合征(BCS)系指肝静脉或(和)下腔静脉(IVC)肝段血流受阻而引起的门静脉高压或(和)下腔静脉高压综合征.我院1990年4月-2003年12月,对782例BCS进行了手术或放射介入治疗,发生术后并发症144例,死亡24例.现将不同术式下并发症的防治护理分析报告如下: 相似文献
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布加综合征(Budd-Chiari Syndrome,BCS)是肝静脉和/或肝段下腔静脉阻塞所引起的一组临床症侯群.BCS的治疗方法较多,其中大球囊扩张是目前治疗下腔静脉阻塞型BCS的有效方法之一,它能提高疗效、减少复发[1],但如果护理不当极易引起各种并发症从而影响疗效. 相似文献
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肝静脉阻塞是引起门静脉高压的一种少见疾病,现报告2例如下。病例1:女,41岁。未育,因发现肝脾肿大14年,伴腹胀、双下肢浮肿4月余入院。既往幼时患“疟疾”有口服避孕药物一年史。体检:慢性病容,无肝掌及蜘蛛痣、皮肤、巩膜无黄染,心肺无异常发现。右侧胸壁静脉显露,血流向上。腹膨隆,上腹壁静脉曲张,血流向上,腹软,肝剑下4cm,肋下3cm,边缘钝,有压痛、表面光滑,质中,肝颈征(-),脾肋下4cm,肝上界在右锁骨中线第四肋间,肝区有叩痛,腹水征(+)。双下肢轻度凹陷性浮肿。B超示肝脾肿大,肝静脉、门静脉增粗,下腔静脉管径变细,右侧胸腔积液,中等量腹水。胃镜示食道静脉轻度曲张。CT:肝脾肿大,腹水。肝肾功能多次检查均在正常范围,胸腹水检查:漏出液。下腔静脉造影:下腔静脉阻塞,阻塞端位于第三腰椎,右腰升静脉、椎间静脉、椎管内静脉形成侧枝循环,肝内静脉扩张。确诊为:肝静脉阻塞综合征。 相似文献
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Wang Zhonggao 《Frontiers of Medicine in China》2007,1(2):130-135
The Budd-Chiari syndrome (BCS) used to be a very rare disorder and lacked a means of relieving. However, various shuntings
and radical procedures have emerged in the last three decades with quite encouraging outcomes. Recent minimally invasive therapies,
such as stenting of the inferior vena cava (IVC), are simple and easy to handle. However, it has been realized that the IVC
stent may compromise the hepatic veins and cause catastrophic consequences, thus the indication for IVC stenting should be
reevaluated and especially not to be overused. Instead, it should be applied by percutaneous transangiography (PTA) only,
which may be repeated when necessary. The BCS in China predominantly belongs to the IVC type rather than the intrahepatic
type in Western; the outcome from its conventional therapy, at least for the moment, is better than that of liver transplantation.
It is thus suggested that, before liver transplantation is decided, the conventional means for managing BCS be considered.
The final suggestion is to restrict the indication both for stenting of the IVC and liver transplantation. In this paper,
ten examples are given with figures. 相似文献
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作者通过下腔静脉或(和)肝静脉造影及B超检查,对41例Budd—chiari综合征血流动力学进行了研究,并结合介入治疗本病的经验体会,提出新的分型及可供选择的治疗方法。Ⅰ型:单纯肝静脉阻塞以球囊扩张为主,如狭窄解除不满意置入内支架,如为肝小静脉泛发性狭窄,可作为TIPSS的适应症。Ⅱ型,膜性或节段性不全阻塞,以球囊扩张为主,选择置入内支架。Ⅲ型:膜性完全阻塞,采用穿通术及球囊扩张。Ⅳ型:节段性完全性闭塞,采用穿通术,球囊扩张及内支架置入。Ⅴ型:伴有多发性下腔静脉膜性或节段性阻塞,以球囊扩张为主,选择性置入内支架。 Ⅱ、Ⅲ、Ⅳ、Ⅴ型如合并肝静脉阻塞需开通肝静脉,如其中1支通畅,肝内侧支循环建立良好,其它肝静脉可不做处理;同样如三支肝静脉均不通,肝内侧支循环建立好,只需开通其中1支肝静脉即可。如下腔静脉节段性闭塞合并肝静脉不通,而肝外侧支循环建立较好,可主要处理肝静脉;如侧支循环建立不好,肝静脉、下腔静脉均应处理。 相似文献
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目的总结肝脏拖出在8例特殊部位肝外伤手术中应用的经验。方法应用肝脏拖出实施第VII段或第VIII段、尾状叶等特殊部位肝外伤手术共8例,行间歇性肝门阻断。其中2例行挫裂伤下腔静脉壁修补,1例在第三肝门肝短静脉逐个结扎后,拖出翻转行尾状叶切除门静脉后壁裂伤修补。术中肝门阻断时间(55±21)min,出血量(2140±750)ml,手术时间(75±42)min。结果全组无手术死亡,手术过程顺利,术中暴露病变清晰,效果满意。结论应用肝脏拖出术,能解决特殊部位肝外伤的术野显露问题,从而为该部位外伤的处理提供良好的视野和空间。 相似文献
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【摘要】目的探讨下腔静脉离断伴奇静脉连接超声声像图特点。方法回顾性分析1例下腔静脉离断伴奇静脉连接患儿的超声声像图表现,查阅文献进行分析讨论。结果下腔静脉离断伴奇静脉连接超声表现为腹主动脉右前方未显示下腔静脉.于腹主动脉右后方显示扩张的奇静脉,并穿过膈肌进入胸腔后回流入上腔静脉,胸骨旁左心室长轴于左心房后方可显示胸主动脉及奇静脉两支血管横断面,肝静脉直接汇入右心房。结论下腔静脉离断伴奇静脉连接十分罕见.具有特征性超声声像图表现。识别其超声表现可提高超声诊断准确率. 相似文献
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Preliminary experience in adult-to-adult living donor liver transplantation in a single center in China 总被引:1,自引:0,他引:1
Yan Lunan Li Bo Zeng Yong Wen Tianfu Zhao Jichun Wang Wentao Yang Jiayin Xu Mingqing Ma Yukui Chen Zheyu Liu Jiangwen Wu Hong 《Frontiers of Medicine in China》2007,1(2):136-141
The aim of this paper is to report the authors’ experience in performing adult-to-adult living donor liver transplantation
(LDLT) by using a modified technique in using grafts of the right lobe of the liver. From January 2002 to September 2006,
56 adult patients underwent LDLT using right lobe grafts at the West China Hospital, Sichuan University Medical School, China.
All patients underwent a modified operation designed to improve the reconstruction of the right hepatic vein (RHV) and the
tributariers of the middle hepatic vein (MHV) by interposing a vessel graft, and by anastomosing the hepatic arteries and
bile ducts. There were no severe complications or deaths in all donors. Fifty-two (92.8%) recipients survived the operations.
Among the 56 recipients, complications were seen in 15 recipients (26.8%), including hepatic vein stricture (one case), small-for-size
syndrome (one case), hepatic artery thrombosis (two cases), intestinal bleeding (one case), bile leakage (two cases), left
subphrenic abscess (one case), renal failure (two cases) and pulmonary infection (five cases). Within three months after transplantation,
four recipients (7.14%) died due to small-for-size syndrome (one case), renal failure (one case) and multiple organ failure
(two cases). All patients underwent direct anastomoses of the RHV and the inferior vena cava (IVC), and in 23 cases, reconstruction
of the right inferior hepatic vein was also done. In 24 patients, the reconstruction of the tributaries of the MHV was also
done by interposing a vessel graft to provide sufficient venous outflow. Trifurcation of the portal vein was seen in nine
cases. Thus, veno-plasty or separate anastomoses were performed. The graft and recipient body weight ratios (GRWR) were between
0.72% and 1.43%, and in three cases it was <0.8%. The graft weight to recipient standard liver volume ratios (GV/SLV) were
between 31.86% and 71.68%, among which four cases had <40%. No “small-for-size syndrome” occurred. With modification of the
surgical technique, especially in the reconstruction of the hepatic vein to provide sufficient venous outflow, living donor
liver grafts in adults using the right lobe of the liver can become a relatively safe procedure and prevent the “small-for-size
syndrome”. 相似文献
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目的 :观察海洛因依赖者眼底血管的变化 ,了解和分析海洛因对机体血管和眼底血管的损害。方法 :对海洛因依赖组 14 5例和对照组 5 0例进行直接检眼镜检查。结果 :海洛因依赖组和对照组分别有 96例 (6 6 2 % )和 3例(6 0 % )眼底血管有异常改变 ,两组比较差异有显著性 (P <0 0 1)。海洛因依赖组的双眼发病率高于单眼 ,(P <0 0 5 ) ;左眼发病率高于右眼 (P <0 0 5 )。结论 :海洛因及其掺杂物对眼底血管有明显损害 ,说明海洛因滥用可导致滥用者的血液循环发生障碍。 相似文献
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目的 通过对布卡综合征(Budd-Chiari Syndrome,BCS)患者和下肢血栓患者白细胞(White Blood Cell,WBC)计数分析来了解我国BCS与炎症间的关系.方法 对BCS患者和下肢血栓患者计数WBC,收集资料,进行统计学分析.结果 BCS患者的WBC计数和下肢血栓患者WBC计数的平均值分别为3.6018和8.8831,t值为-8.872,P<0.001.结论 我国的BCS主要病因可能不是炎症造成的,在发病过程中可能也没有血栓的参与. 相似文献
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G M Pacifici G F Placidi 《European journal of drug metabolism and pharmacokinetics》1982,7(2):119-122
The liver first pass effect of pinazepam in four anaesthetized rabbits was determined by measuring the concentrations of this compound and those of its metabolite N-desmethyldiazepam in the plasma from the portal and hepatic veins. Anaesthesia was induced with an i.p. injection of urethane (1.5 g/kg). Portal and hepatic veins were exposed by midline incision. Pinazepam (20 mg/kg) was orally administered in a single dose by stomach intubation. Blood was simultaneously drawn from the portal and hepatic veins of each rabbit at different intervals after dosing. Pinazepam plasma levels were significantly higher in portal than hepatic vein. While N-desmethyldiazepam concentrations were significantly higher in the hepatic than portal vein plasma. Therefore, it has been demonstrated that the rabbit liver extracts pinazepam from the blood and converts this compound into N-desmethyldiazepam. 相似文献
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目的 探讨糖尿病视网膜病变(DR)与血清IV胶原(IVC)、层粘连蛋白(LN)之间的关系。 方法 143例 2型糖尿病患者作为病例组,并依据视网膜病变情况分为三组:无视网膜病变组(NDR)58例,背景期视网膜病变组(BDR)47例,增殖期视网膜病变组(PDR)38例。同时设健康体检者55人为对照组。采用放射免疫法测其血清IVC、LN的含量。所有检测者均测定空腹血糖、糖化血红蛋白、血脂、尿白蛋白排泄率、体重指数,分析病例组血清IVC、LN水平与视网膜病变的关系。结果 (1)血清IV-C水平:三组糖尿病患者明显高于对照组(P<0.01)。病例组间比较,PDR组高于BDR组,BDR组高于NDR组,差异均有非常显著意义(P<0.01)。(2)血清LN水平:BDR组、PDR组高于对照组,差异均有非常显著意义(P<0.01),NDR组与对照组比较,增高不明显,无统计学意义(P>0.05)。病例组间比较,PDR组高于BDR组,BDR组高于NDR组,差异均有非常显著意义(P<0.01)。(3)Logistic多元回归分析显示,血清IVC、LN、病程是DR发病的独立风险因素。结论 血清IVC、LN与DR发生发展密切相关,联合检测血清IVC、LN水平,有助于估计DR病变程度及预后。 相似文献
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目的探讨三维动态增强MR血管成像所显示门静脉高压患者侧支循环的分布情况。方法选取我院检查的69例门静脉高压患者,并进行门静脉系统的3DDCEMRA检查,对减影后的影像学资料及MIP重建图像进行分析,统计侧支循环的分布情况。结果69例门静脉高压患者中,食管和食管周围静脉曲张45例,胃底静脉曲张47例,奇/半奇静脉曲张35例;胃左静脉曲张34例,胃后静脉曲张11例,胃-肾分流13例;脾周静脉曲张14例,脾-肾分流者4例;附脐静脉曲张21例;性腺静脉曲张17例。结论3DDCEMRA不仅能发现门静脉高压患者的曲张的侧支循环,还可以明确血管起止、走行和毗邻关系。 相似文献