彩色多普勒对肝癌肝动脉栓塞治疗前后肝血管的血流动力学研究

本文应用彩色多普勒血流成像（ＣＤＦＩ）对２５例原发性肝癌（ＨＣＣ）患者行肝动脉栓塞（ＴＡＥ）治疗前后肝血管的血流动力学变化进行了研究，结果表明：（１）ＴＡＥ后，肝动脉血流减少，而ＲＩ及ＰＩ无明显改变；（２）门静脉血流于ＴＡＥ后第一周开始增加，第二周达高峰，血流量平均增加了２９２．９８ｍｌ／ｍｉｎ，第四周恢复治疗前的血流，而肝动脉血流又增加，肝静脉的血流于治疗前后无明显改变。     

彩色多普勒对肝癌直动脉栓塞治疗前后肝血管的血流动力学研究

本文应用彩色多普勒血流成像对２５例原发性直癌患者行肝动脉栓塞治疗前后肝血管的血流动力学变化进行了研究，结果表明：９１）ＴＡＥ后，直动脉血流减少，而ＲＩ及ＰＩ无明显改变；（２）门静脉血流于ＴＡＥ后第一同时合并血肿周开始增加，第二周达高峰，血流量平均增加了２９２．９８ｍｌ／ｍｉｎ，第四周恢复治疗前后的血流，而肝动脉血双增加，肝静脉的血流于治疗前后无明显改变。     

彩色多普勒超声在肝癌肝动脉和门静脉双重栓塞治疗中的应用价值

本文应用彩色多普勒血流显像观察肝癌肝动脉栓塞（ＴＡＥ）及肝动脉和门静脉双重栓塞（ＴＡＥ＋ＰＶＥ）治疗前后肿瘤血供和声像图的变化以及二者之间的关系。结果显示ＴＡＥ后，肿瘤门静脉供血从２０．９％增加到５５．６％。在ＴＡＥ基础上行ＰＶＥ治疗，使肿瘤动脉供血和门静脉供血均明显减少。肝癌化疗栓塞后肿瘤缩小程度与血供减少程度密切相关。经双重栓塞治疗的肝癌患者临床预后优于单纯经ＴＡＥ治疗者。结果表明彩色多普勒超声在指导临床介入件治疗药物用量和评价介入性治疗效果起重要作用。     

220例肝癌患者肝动脉栓塞术前后肝动脉血流动力学的超声影像分析

应用彩色多普勒超声（ＣＤＦＩ）对２２０例原发性肝癌（ＨＣＣ）患者肝动脉化疗及栓塞术（ＴＡＥ）前后肿瘤血供，肝动脉血流动力学改变进行了观察。结果表明：①肝癌主要由肝动脉供血，少部分由门静脉供给；②ＴＡＥ后肿瘤内部及周边动脉血流明显减少（Ｐ＜０．０５）；③肝动脉收缩期最大流速（Ｖｍａｘ）、舒张期最小流速（Ｖｍｉｎ）均明显下降（Ｐ＜０．０５），阻力指数（ＲＩ）和肝动脉直径改变不明显（Ｐ＞０．０５）；④ＴＡＥ后瘤体明显减小（Ｐ＜０．００１）。认为在行ＴＡＥ前后，应用ＣＤＦＩ对肿瘤血供、肝动脉血流动力学进行观察分析，可给ＴＡＥ预后提供重要指标，给重复治疗提供依据。ＣＤＦＩ是目前肝癌肝动脉栓塞治疗前后最好的影像学检查方法     

原发性肝癌肝动脉栓塞治疗前后肿瘤血管的血流动力学改变

原发性肝癌肝动脉栓塞治疗前后肿瘤血管的血流动力学改变解放军第二疗养院（７１０６００）超声科王绍林第四军医大学西京医院超声科王全华原发性肝癌（ＨＣＣ）肝动脉栓塞（ＴＡＥ）治疗已广泛开展，并且是治疗中、晚期ＨＣＣ的有效方法〔１〕。本文应用彩色多普勒（ＣＤ...     

肝癌患者多次化疗栓塞术后肝纤维化指标变化

目的：探讨多次肝动脉化疗栓塞术（ＴＡＣＥ）对肝纤维化进程的影响,材料与方法：选择２４例经三次以上ＴＡＣＥ治疗的肝癌患者,测定每次ＴＡＣＥ治疗前后透明质酸（ＨＡ）、人Ⅲ型前胶原（ｈｐｃⅢ）和Ⅳ型胶原（Ⅳ．Ｃ）的血清学水平,并进行比较研究。结果：ＴＡＣＥ治疗前后对比,三次肝纤维化指标均有不同程度的升高,以第三次ＴＡＣＥ术后升高最明显（Ｐ〈０．０１）,三项肝纤维化指标中,以Ⅳ．Ｃ变化最显著。第一次ＴＡＣ     

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。     

肝母细胞瘤肝动脉栓塞化疗前后彩超观察血流改变及临床意义

目的：研究肝母细胞瘤肝动脉栓塞化疗前后血流动力学改变及血流动力学变化对栓塞化疗效果的影响。方法：运用彩色多普勒B超监测4例巨大肝母细胞瘤患儿在介入治疗前，介入治疗后1周，2周，3周，4周时肝脏及瘤体的血流动力学变化和肿瘤大小改变。结果：介入治疗前肝母细胞瘤全肝供血增加，介入治疗后近期，表现为肝固有动脉血流量骤减和门静脉血流量代偿性增加，随着介入治疗后时间的延长，肝固有动脉血流量进一步降低，而门静脉血流量则逐渐恢复到治疗前水平，肝脏和肿瘤的血供均明显减少，这一变化与肿瘤的缩小呈正比例，当介入治疗后时间超过3周时，肝脏和肿瘤的血供又有不同程度增加，提示再次介入治疗的必要。结论：彩色多普勒超声能准确反映肝母细胞瘤动脉栓塞化疗前后的血供变化，肝母细胞瘤介入治疗前后血流动力学改变的监测对判断介入治疗的预后以及选择再次介入治疗或手术治疗的时机具有重要的临床意义。     

肝动脉化疗栓塞治疗肝癌侵犯门静脉的疗效和安全性探讨

肝动脉化疗栓塞治疗肝癌侵犯门静脉的疗效和安全性探讨陈自谦①陈君坤曹建民王中秋王鸣朱锡旭笔者自１９９１年１月至１９９６年４月对５４例肝癌合并门静脉侵犯进行了ＴＡＣＥ治疗，现着重探讨ＴＡＣＥ治疗的疗效和安全性。１材料和方法本组５４例，男４４例，女１０例，...     

彩色多普勒超声在选择性门静脉联合肝动脉栓塞治疗中晚？…

目的 探讨彩色多普勒超声对经皮肝选择性门静脉栓塞化疗（ＳＰＶＥ）联合肝动脉栓塞（ＴＡＥ）治疗中晚期肝癌的应用价值。方法 彩超引导６５例不能手术的中晚期肝癌在ＴＡＥ基础上行ＳＰＶＥ术,同时一组与单纯ＴＡＥ对照组治疗前后的肿瘤血供变化、声像图特征及与临床疗效的关系。结果 ①本组肿瘤血供本组与单纯ＴＡＥ对照组治疗前后的肿瘤血供消失和率９２．３％,其中动脉血流消失和减少率８９．２％,门静脉血流消失和减少率     

彩色多普勒超声对原发性肝癌肝动脉栓塞前后肝血管的血流动力学观察

目的观察原发性肝癌肝动脉栓塞前后肝血管的血流动力学改变。方法应用彩色多普勒超声(CDFI)对60例原发性肝癌患者行肝动脉栓塞(TAE)治疗前后肝血管的血流动力学变化进行研究。结果(1)TAE后肝动脉血流减少(P<0.05),而阻力指数(RI)和肝动脉内径改变不明显(P>0.05);(2)门静脉血流于TAE后增加(P<0.05),门静脉内径无明显变化(P>0.05);(3)TAE后瘤体明显缩小,瘤体血供减少(P<0.05);(4)肝静脉的血流治疗前后无明显改变(P>0.05)。结论CDFI是观察原发性肝癌肝动脉栓塞治疗前后较好的影像学检查方法。     

Doppler sonographic diagnosis of severe portal vein pulsatility in constrictive pericarditis: Flow normalization after pericardiectomy

This case report describes the noninvasive assessment of hepatic and portal vein hemodynamics in a patient with constrictive pericarditis before and after pericardiectomy. Doppler sonography of the hepatic veins demonstrated a typical W‐shaped pattern with pronounced late diastolic flow reversal that disappeared after surgery. Preoperatively, we observed severe pulsatility of the portal vein with flow reversal in systole; after pericardiectomy, portal venous flow was normal. We concluded that the high right atrial pressure in this patient might have led to increased hepatic venous outflow resistance, with subsequent trans‐sinusoidal shunting between the hepatic artery and portal vein causing severe portal vein pulsatility. After pericardiectomy and a decrease in right atrial pressure, portal vein flow normalized. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:84–88, 1999.     

超声对门静脉高压症断流术前后腹腔动脉及其分支的血流动力学测定

目的：测定正常人与门静脉高压症（PH）患者腹腔动脉、肝动脉、脾动脉血流参数,观察PH断流术前后各血管流动力学变化。方法：应用彩色多普勒测量115例正常人、46例PH患者及43例PH患者断流术前后的腹腔动脉、肝动脉、脾动脉的血流参数,并对其进行统计学处理。结果：PH患者与正常人比较,肝动脉血液流速变慢（P＜0．05）、血流量减少（P＜0．01）,脾动脉直径增粗（P＜0．01）、血流量增多（P＜0．01）。PH患者断流术后肝动脉血流量增多（P＜0．05）,腹腔动脉流量减少（P＜0．05）。术后门静脉血栓（PVT）发生率为27．9％（12／43）,50％发生于左支。结论：PH时肝动脉血流量（HAF）减少,脾动脉血流量明显增加。断流术后肝动脉血流量较术前增加。     

双功多普勒检测门脉血流动力学的临床应用

应用双功多普勒检测了３２例正常对照者，３８例慢性肝炎，１７例肝硬化和３２例原发性肝癌患者的门脉血流动力学，发现肝硬化，原发性肝癌组门静脉内径显著大于正常对照组和慢性肝炎组；门脉血流速度则三组患者均显著低于对照组；门脉血流量仅慢性肝炎组显著低于对照组；三组患者的门脉充血指数均显著大于对照组。本文初步探讨了门脉血流动力学检测的临床意义及各种生理因素对门脉血流的影响。     

临潼矿泉对人体作用的系列研究--矿泉浴对肝血流动力学影响

目的 探讨临潼矿泉对肝血流的影响。方法 利用彩色多普勒超声对40例正常人矿泉浴前后测量肝血管的血流情况。结果 矿泉浴后肝动脉、门静脉及肝静脉血流均增加，肝静脉血流增加明显，而动脉阻力指数、搏动指数及静脉充盈指数无明显改变。结论 矿泉浴有提高肝脏血液循环的作用。     

Does PEEP impair the hepatic outflow in patients following liver transplantation?

Objective Evaluation of the impact of end-expiratory pressure (PEEP) ventilation on venous liver outflow, portal vein, and hepatic artery flows as well as systemic hemodynamics in patients following liver transplantation (LT).Design Prospective, interventional patient study.Setting University hospital intensive care unit.Patients 65 consecutive patients after LTInterventions All patients were intubated and mechanically ventilated with biphasic positive airway pressure (BIPAP). The effects of three levels of PEEP (0, 5, and 10 mbar) applied at random order on hepatic inflow and outflow were studied in the immediate postoperative period.Measurement and results Central venous-, arterial pressure, and cardiac index was recorded from every patient at three different PEEP levels (0, 5, and 10 mbar). Simultaneously, flow velocities in the hepatic-, portal vein, and hepatic artery were determined by Doppler ultrasound. PEEP of 10 mbar significantly increased central venous pressure in comparison with zero PEEP. Mean arterial pressure and cardiac index was not influenced. Hepatic inflow and outflow of the transplanted livers were not impaired by any of the used PEEP levels.Conclusions BIPAP ventilation with PEEP levels up to 10 mbar does not affect systemic hemodynamics. Furthermore, neither venous outflow nor portal venous or hepatic artery inflow of the liver are impaired at PEEP levels up to 10 mbar immediately following liver transplantation. Although these results suggest that PEEP ventilation up to 10 mbar does not affect liver hemodynamics, further studies are needed to determine whether these findings could be confirmed for a longer ventilation period with PEEP.     

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。     

Effect of respiration,exercise, and food intake on hepatic vein circulation.

Since the effects of respiration, nutrition, and exercise on blood flow in the hepatic vein are not well understood, the objective of this study was to determine the hemodynamic influence of these factors on hepatic venous circulation using Doppler ultrasonographic tracings. The venous blood flow of the middle hepatic vein was determined during arrested full inspiration, midinspiration, and expiration in 25 healthy subjects. The maximum velocity and the systolic-to-diastolic ratio of the blood flow were measured. The portal vein blood flow velocity was measured in 20 volunteers before and after food intake. The portal vein blood flow and the hepatic vein flow velocity were examined in eight volunteers after exercise. During inspiration, maximum blood flow velocity of the hepatic veins decreased compared to midinspiration (P < 0.001). With expiration the maximum velocity increased (P < 0.001). After food consumption, there was no change in the velocity of the hepatic veins, but the portal vein blood flow increased (P = 0.041). After physical exercises, the maximum velocity of the hepatic venous flow increased, on average, about 148% (P = 0.01), and the portal vein blood flow decreased about 44% (P = 0.027). To achieve standard measurements of hepatic venous blood flow, the state of respiration and physical exertion should be established. The nutritional status had only a minor influence on hepatic vein measurements.