多层螺旋CT对胰周血管的显示研究

目的探讨多层螺旋CT对胰腺周围血管的显示能力。方法将225例接受上腹部增强CT的患者的扫描资料分别按动脉期和门脉期薄层重建,使用容积再现(VR)和多层面容积重建(MPVR)进行血管成像,观察两种成像方式对胰腺周围动脉、静脉的显示情况。结果多层螺旋CT对正常胰腺周围大动脉(腹腔干,肝总动脉,脾动脉,胃十二指肠动脉,肠系膜上动脉)的显示率为100%,对小动脉(胰背动脉,胰横动脉,胰大动脉,胰尾动脉,胰十二指肠上动脉,胰十二指肠下动脉)的显示率为33.8%~96.0%。所显示的胰背动脉起源变异较多,胰背动脉起源于脾动脉,肝总动脉,腹腔干,肠系膜上动脉的比例分别为55.1%、9.7%、10.6%和24.5%。对胰腺周围大静脉(脾静脉,肠系膜上静脉,门静脉主干)的显示率为100%;胰头部小静脉(胰十二指肠上前静脉,胃结肠干及其属支)的显示率为85.3%和77.3%。对于胰腺周围小血管,MPVR较VR具有较强的显示能力。结论多层螺旋CT对胰腺周围大血管具有可靠、稳定的显示率;对胰腺周围小血管也具有一定的显示能力。     

Three‐Dimensional Ultrasonographic Depiction of Fetal Abdominal Blood Vessels

Objective. The purpose of this study was to identify fetal abdominal vasculature with 3‐dimensional (3D) ultrasonography and to describe a systematic method for analysis of volume data sets. Methods. Three‐dimensional volumes of the fetal abdomen were acquired prospectively in 30 patients between 15 and 34 weeks' gestation with color Doppler, high‐definition (HD) flow, power Doppler, and B‐flow imaging. All volumes were analyzed offline by 2 examiners separately. The feasibility of identifying the fetal abdominal blood vessels was analyzed. A standardized approach was applied to identify specific vessels by correlating the images with known anatomic landmarks. Results. The volumes were rotated into an anatomic orientation in the multiplanar mode, and then the vessels were identified in the following order: aorta (30 of 30), celiac trunk (29 of 30), superior mesenteric vein (28 of 30 and 26 of 30 for readers 1 and 2, respectively), superior mesenteric artery (29 of 30), left renal artery (25 of 30 and 26 of 30), right renal artery (27 of 30), common iliac arteries (30 of 30), umbilical arteries (26 of 27), external iliac arteries (20 of 22), umbilical vein (29 of 30), ductus venosus (30 of 30), hepatic vein (29 of 30), right portal vein (29 of 30), inferior vena cava (28 of 30), adrenal artery (2 of 30), hepatic artery (24 of 30 and 23 of 30), splenic artery (24 of 30 and 23 of 30), gastric artery (14 of 30 and 9 of 30), splenic vein (19 of 30 and 15 of 30), and renal vein (1 of 30). A step‐by‐step systematic approach to identify the abdominal vasculature from the ultrasonographic volume data set was developed. Conclusions. Fetal abdominal vessels can be easily visualized when a systematic analysis is performed on 3D data set volumes. Visualization of the vessels was optimal when volumes were acquired with HD flow imaging.     

CT评价急性胰腺炎疗效一个新指标: 肠系膜上动脉与静脉比值

本文通过用双螺旋ＣＴ扫描，测量ＳＭＡ（ＳｕｐｅｒｉｏｒＭｅｓｅｎｔｅｒｉｃＡｒｔｅｒｙ）和ＳＭＶ（Ｓｕｐｅ－ｒｉｏｒＭｅｓｅｎｔｅｒｉｃＶｅｉｎ）的直径，ＳＭＡ直径测量恰好在ＳＭＡ的起始部，ＳＭＶ直径测量恰好在ＳＭＶ与门静脉汇合前。计算２０例急性胰腺炎治疗前后ＳＭＡ／ＡＭＶ的值。治疗后ＳＭＡ／ＳＭＶ的值均比治疗前的增大。结论是：有效治疗后ＳＭＡ／ＳＭＶ的值是评价急性胰腺炎疗效一个有效的新指标。     

单次屏气三维动态增强磁共振门静脉成像技术及初步应用体会

目的 探讨单次屏气三维动态增强磁共振门静脉成像(3D DCE MRP)技术的可靠性及临床应用价值。方法 对40例受检行常规轴位T1W，T2W成像后，进行冠状位3D DCE MRP，连续扫描3组数据，对感兴趣区血管的原始图像用最大强度投影法重建。评价图像质量，分析门静脉、脾静脉、肠系膜上静脉显示情况和有无侧支循环形成。扫描前经静脉快速注射钆喷酸葡胺20—30ml。结果 39例门静脉图像质量达到诊断要求，1例血管图像模糊。20例无门静脉高压症患的肠系膜上静脉、脾静脉、门静脉主干及其肝内3—5级分支均显示良好，门静脉高压症可出现肠系膜上静脉及门静脉增宽、门静脉栓塞、肝内门静脉分支级数减少、脾静脉迂曲增粗以及侧支血管形成。结论 3D DCE MRP是了解门静脉系统结构的可靠方法，可用于肝脏多种疾病的诊断和疗效评价。     

Gray scale sonographic anatomy of the pancreas.

With the development of gray scale, the appearance of pancreatic anatomy and its relationship to surrounding structures can be demonstrated more effectively. Gray scale has made it possible to identify such vessels as the portal vein, superior mesenteric vein, superior mesenteric artery, splenic vein, etc. This makes it possible to identify the pancreas more precisely. The normal pancreas appears to have a fairly specific echo pattern. The pancreas scanning techniques used in this study include the oblique, transverse, and longitudinal sections. Oblique views are especially useful.     

Feasibility spectrum for Doppler flowmetry of splanchnic vessels. In normal and cirrhotic populations

The calculation of absolute blood flow by Doppler flowmetry requires adequate visualization of a vessel in both transverse and longitudinal planes and an insonating angle less than 60 degrees. The percentage of the splanchnic vessels in a given population in which these criteria could be fulfilled (ie, the feasibility spectrum) is not known. To identify this spectrum in our patient sample, 100 consecutive nonselected patients (58 female, 42 male) and 34 cirrhotics (31 male, three female) were prospectively studied. In addition, from the group of 42 nonselected patients, 31 males with no evidence of liver disease were matched for age, weight, and height with the 31 male cirrhotics. The echo-Doppler feasibility (EDF; success percentage) was determined for the hepatic, superior mesenteric, and splenic arteries and portal, superior mesenteric, and splenic veins. In the nonselected sample, the EDF varied from 86% for the portal vein to 60% for the superior mesenteric artery. In cirrhotics, the EDF ranged from 88% for portal vein to 29% in splenic artery. The total EDF for the nonselected sample (68%) was significantly higher than the EDF for cirrhotics (54%; P less than .001). Physical factors (weight, age, height, and sex) affected the EDF in the nonselected patient sample but not in cirrhotics. We conclude that analysis of EDF of splanchnic vessels in these groups clearly demonstrates that the composition of the patient sample has an important bearing on the feasibility spectrum of Doppler study. Female subjects who are thin, young, and short and lighter male patients are better candidates for abdominal Doppler flowmetry.     

肾移植10年514例术后尿瘘23例:分类及治疗

对解放军成都军区总医院1998-12/2008-12肾移植后出现尿瘘23例患者的病因、诊断及治疗结果进行回顾性分析.23例中行1次肾移植21例,2次2例;吻合方式9例采用肾动、静脉与髂外动、静脉端侧吻合,14例采用肾动脉与髂内动脉,肾静脉与髂外静脉吻合.23例患者随访6～12个月,17例为移植后3～7 d发生尿瘘,6例为移植后7～10 d发生;17例为吻合口瘘,4例为输尿管远端坏死,2例为肾盂瘘.保守治疗11例,手术治疗12例.手术患者中,9例采用常规手术方法的患者有1例再次出现尿瘘,经二次手术后治愈;3例采用带蒂大网膜修补法,尿瘘无复发,移植肾B超检查无积水,患者肾功能正常.手术一次成功率92%(11/12),其中采用带蒂大网膜修补法成功率为100%.提示尿瘘最重要的是预防,从取肾、修肾到手术中都要注意保护输尿管,同时注意输尿管与膀胱的吻合技巧,避免因手术原因导致吻合口瘘,这样才能减少尿瘘的发生,同时一旦出现尿瘘后应根据不同情况及时处理,这样才能最大程度减少尿瘘对移植肾功能的损害.     

多层螺旋CT胰腺双期血管成像研究

目的　探讨多层螺旋CT胰腺双期血管成像的可行性及其临床应用。方法　 46例疑胰腺癌患者行多层螺旋CT多期扫描 ,分别于动脉期和门静脉期进行血管成像。统计SSD、MIP及VR成像对正常腹腔动脉及其分支的显示率 ,统计门脉期VR成像对正常门静脉主干及其属支的显示情况。结果　VR成像对正常腹腔动脉、肠系膜上动脉、胃十二指肠动脉的显示率分别为 10 0 %、10 0 %、90 .9%。对正常门静脉主干、脾静脉、肠系膜上静脉的显示率均为 10 0 %。根据肿瘤浸润血管的情况作出可切除性判断。结论　多层螺旋CT胰腺双期血管成像是了解胰周血管情况的无创性检查方法 ,具有可行性及临床应用价值。     

超声诊断小儿肠旋转不良

目的 探讨彩色及二维超声诊断小儿肠旋转不良及肠扭转的可能性。方法 ２８例肠旋转不良患儿,９例为前瞻性探测（７例手术证实）,１９例为肠旋转不良术后随访。结果 ７例肠旋转不良术前超声显示：６例肠幕 血管关系异常,诊断为肠旋转不良,其中５例超声发现“漩涡征”诊断合并肠扭转（手术证实６例合并肠扭转）。２例超声发现肠系膜上血管关系异常,后经消化道造影证实肠旋转不良（未手术）。超声随访１９例肠旋转不良术后患儿     

床旁超声在同期胰肾联合移植治疗I型糖尿病术后的检查思路与探讨

目的总结床旁超声在胰肾联合移植（SPK）术后的应用,并就超声扫查思路、超声参考参数及术后并发症等方面做相关探讨。 方法回顾性分析2009年7月至2020年12月于北京朝阳医院行胰肾联合移植术后超声评估的I型糖尿病患者计6位,记为1~6,分析总结其血管重建术式、胰腺动静脉的血流动力学参数、并发症等情况。 结果6位患者中4位患者术后出现胰肾免疫排斥反应,胰腺内动脉的血流阻力指数均升高,阻力指数（RI）为0.74_~0.87,峰值流速（PSV）为87~90 cm/s;另2位患者胰腺动脉RI分别为0.69、0.72;且该4位患者移植胰腺与移植肾脏均同期出现并发症;6位患者的回流静脉吻合方式均为经体循环回流,其中1例患者为供体门静脉与受体的髂外静脉端侧吻合,另5例为供体的门静脉与受体的下腔静脉端侧吻合;该6位患者血管重建的方式均为“Y”型血管吻合,供肾的肾动脉与供体的髂内动脉吻合、供体的腹主动脉袖片（包含腹腔干与肠系膜上动脉）与供体的髂外动脉吻合、供体的髂总动脉与受体的髂外动脉的端侧吻合。 结论床旁超声在对胰肾联合移植术后器官功能评估中有较大的临床应用价值,重建的血管是扫查要点,超声医师的诊断思路需要与外术的具体操作密切结合。     

慢性Leriche综合征侧支动脉开放类型的CT分析

目的分析慢性主髂动脉闭塞(Leriche综合征)的CT表现,总结该病侧支动脉开放类型,提高对慢性Leriche综合征的认识。方法回顾性收集本院2016年1月~2018年9月确诊为慢性Leriche综合征患者36例。36例患者治疗前均行主动脉CTA检查。24例行主动脉-股动脉人工血管旁路移植术和6例行介入治疗(球囊扩张和/或支架成形术);6例行内科治疗。结果36例主髂动脉CTA均表现为腹主动脉-髂总动脉分叉闭塞,根据闭塞近心端(上端)位置分3型:(1)近肾动脉旁型16例;(2)肠系膜下动脉上型8例;(3)肠系膜下动脉下型12例。全部病例闭塞或次全闭塞远心端(下端)达单侧或双侧髂内、外动脉水平。36例慢性Leriche综合征侧支动脉开放类型有5种:(1)A型(Winslow通路,出现率100%,36/36),开放侧支为双侧腹壁上动脉,通过胸廓内动脉与腹壁下动脉吻合,连接于髂外动脉。(2)B型(出现率92%,33/36):开放侧支为双侧下肋间动脉、肋下动脉/腰动脉,通过旋髂深动脉连接髂外动脉或股动脉。(3)C型(出现率50%,18/36):开放侧支为肠系膜上动脉分支(中结肠动脉),通过Riolan弓连接肠系膜下动脉或其分支直肠上动脉。(4)D型(出现率36%,13/36):开放侧支为双侧或单侧肋下动脉,通过髂腰动脉连接髂内动脉。(5)E型(出现率53%,19/36):开放侧支为直肠上动脉,通过骶动脉丛/直肠下动脉连接髂内动脉。A型和B型侧支动脉的开放可提供下腹壁和下肢动脉的血供。C型出现于闭塞近端位于肠系膜下动脉以上的患者,以代偿肠系膜下动脉供血区的血运。D型和E型为少见类型。结论慢性Leriche综合征患者的侧支动脉开放有多种类型,侧支动脉开放与主髂动脉闭塞范围相关。正确识别和描述侧支动脉有助于为临床提供更全面的诊断信息。     

Ultrasound examination of the liver: Variations in the vascular anatomy

The hepatic vasculature is highly complex. The hepatic artery (a branch of the celiac tripod) and the portal vein (formed by the confluence of the splenic and superior mesenteric veins) provide a dual blood supply while venous drainage is guaranteed by the hepatic veins. There are also numerous anatomic variants that can involve one or more of the system’s three components.Hepatic artery variants are the least common. Ten types have been identified, including several that are fairly frequent and others that are quite rare, and the variation generally involves the extrahepatic portion of the vessel. Portal vein variants are found in around 20% of the population. They can involve the main portal trunk or segmental branches. Variants of the hepatic veins are the most common. They involve the number and course (supernumerary veins) or the number, course, and openings (accessory veins).Knowledge of portal vein and hepatic vein variants, which are extremely common, is of prime importance for precise localization of lesions. Hepatic artery variants are equally important for surgical treatment of hepatic disease, especially liver transplantation, where it is essential for preoperative workup and postoperative follow-up of the recipient as well as for assessment of potential donors.     

Intraoperative US diagnosis of pylephlebitis (portal vein thrombosis) as a complication of appendicitis: a case report

We report a case of infectious thrombosis of the superior mesenteric vein (pylephlebitis) that was suspected preoperatively with computed tomography and confirmed at intraoperative ultrasonography as confined to the extrahepatic portal vein and superior mesenteric vein. Intraoperative ultrasonography revealed intraluminal echogenic thrombus material in the dilated superior mesenteric and extrahepatic portal veins, slightly dilated open splenic vein, and numerous venous collaterals in the hepatoduodenal ligament. When preoperative imaging studies are inconclusive, intraoperative sonography can confirm the correct diagnosis of pylephlebitis and may give valuable information about the extent of the thrombosis. Received: 19 December 1995/Accepted: 31 January 1996     

胰腺癌胰周血管受侵的MSCT表现及可切除性评估

目的探讨胰腺癌胰周血管受侵的MSCT表现及与手术结果的比较。方法 80例胰腺癌患者(后经临床综合诊断或病理证实)行MSCT三期增强扫描及三维重组。根据重建图像结合横断位图像对胰周主要血管进行识别。胰周主要血管包括腹腔动脉(CA),肠系膜上动脉(SMA),脾动脉(SA);门静脉(PV),脾静脉(SV),肠系膜上静脉(SMV)。将胰腺癌与血管的关系分为0～4级。评价270条胰周主要血管的影像资料,并与手术结果对照,分别计算各分级敏感性、特异性、阳性预测值及阴性预测值和准确率。结果不同部位、不同大小的肿瘤侵犯的胰周血管及其程度各不相同,随着MSCT分级的增高,对于胰腺癌手术可切除性判断的敏感性逐渐降低,而特异性逐渐升高。对于手术可切除性判断的敏感性、特异性均较高的MSCT影像分级是2级。结论多层螺旋CT胰周血管成像提高了胰腺癌的早期诊断率及手术可切除性判断的准确率。     

Effect of norepinephrine on canine plasma concentrations of enkephalin-like material

Norepinephrine (0.35 microgram/kg/min) was infused continuously for 20 min into either the carotid, femoral or superior mesenteric arteries of anesthetized, vagotomized and splenectomized dogs. Blood flow in these arteries was monitored continuously. Blood samples were taken from the aorta, jugular or femoral vein and the superior mesenteric and hepatic veins at 5-min intervals during a 20-min preinfusion period, the 20-min infusion period and a 20-min postinfusion interval. Blood samples were analyzed by radioimmunoassay with antibodies raised against Leu- and Met-enkephalin. Norepinephrine infused into the carotid or femoral arteries did not affect plasma levels of enkephalin-like material. By contrast, plasma concentrations of both Leu- and Met-enkephalin-like material were more than doubled during norepinephrine infusion into the superior mesenteric artery, P less than .001. This increase in enkephalin-like material occurred in arterial as well as venous blood. Neither infusion of vasopressin nor prostaglandin F2 alpha into the superior mesenteric artery elicited a rise in plasma levels of enkephalin-like material. In adrenalectomized dogs, when norepinephrine was infused into the superior mesenteric artery, there was again a statistically significant elevation in plasma concentrations of both Leu- and Met-enkephalin-like material.     

增强MRI评估慢性乙型肝炎及乙型肝炎后肝硬化肝脏血管直径的变化

目的利用增强MRI评估慢性乙型肝炎(CHB)及乙型肝炎(乙肝)后肝硬化时肝内外血管直径的变化。方法回顾性分析49例CHB、乙肝后肝硬化患者及18例正常对照者动态增强MRI显示的肝内外血管的直径,分析其与肝纤维化程度的关系。结果肝右静脉(rs=-0.492)、肝中静脉(rs=-0.545)和肝左静脉(rs=-0.423)直径与肝纤维化程度呈负相关(P<0.05),门脉右支(rs=0.573)、门脉主干(rs=0.598)、脾静脉(rs=0.478)和肠系膜上静脉(rs=0.510)直径与肝纤维化程度呈正相关(P<0.05);而腹腔干、脾动脉、肝总动脉、肠系膜上动脉及门脉左支直径与肝纤维化程度无相关(P均>0.05)。结论随着肝纤维化程度加重,肝静脉逐渐变窄,门脉系统逐渐增宽,肝周动脉变化不明显。     

Varicocele and the testicular-renal venous route: hemodynamic Doppler sonographic investigation.

The aim of this study was to quantify the anatomic and hemodynamic components of the testicular venous drainage for the purpose of understanding their mechanisms of interacting in producing mutual effects, such as "nutcracker" phenomenon, reflux, and varicoceles. Seventy-five male subjects were studied at rest and during Valsalva maneuver. Aortomesenteric distance and angle, flow velocity in different segments of the renal veins, testicular vein diameter, and flow inversion were evaluated using standard ultrasound equipment with spectral and color Doppler capabilities. The velocity of flow in the proximal segment of the left renal vein (17.5 cm/s) was found to be significantly lower than that in both the distal left renal vein (121 cm/s) and the right renal vein (37 cm/s). The flow velocity in the proximal left renal vein decreased with decrease in the aortomesenteric distance and angle. Testicular vein diameters greater than 3 mm were statistically associated with decreased superior mesenteric artery angle. A significant association also was found between the left testicular vein diameter (in Valsalva maneuver) and inversion of flow. The decrease in flow velocity in the left renal vein proximal to the bifurcation of the superior mesenteric artery from the aorta supports the "nutcracker" theory. An association was found between the decrease of superior mesenteric artery angle and the increase in testicular vein diameter. Another association exists between the presence of reflux during Valsalva maneuver and increased testicular vein diameter. These finding were significant only for testicular vein diameter values greater than 3 mm.     

肿瘤与血管接触三级评价法在胰腺癌术前评价中的价值

目的 探讨多排螺旋CT(multidetector CT, MDCT)肿瘤与血管接触（tumor vessel contact, TVC）三级评价法在胰腺癌术前评价中的应用价值。方法 选取2017年1月至2019年3月在河南省南阳市中心医院行手术治疗的胰腺癌患者80例,术前给予MDCT检查,比较TVC三级评价法与手术探查结果的一致性。结果 80例患者,手术中共探查408支胰周血管,其中腹腔干81支,肝总动脉87支,肠系膜上动脉82支,肠系膜上静脉76支,门静脉81支;与TVC三级评价法分析一致性κ检验结果分别为0.770、0.731、0.697、0.509和0.688,P<0.05;TVC三级评价法显示侵犯的周围器官主要为十二指肠,诊断胰周血管侵犯可切除的灵敏性、特异性、阳性预测值和阴性预测值分别为100.00%、62.50%、96.07%和100.00%。肿物侵犯周围器官主要为十二指肠;CT诊断肿物可切除的灵敏性、特异性、阳性预测值和阴性预测值分别为78.00%、79.50%、80.00%和77.50%。结论 进行TVC三级评价法在可手术胰腺癌患者术前评价中有较好的应用价值,值...     

多层螺旋CT静脉血管成像价值探讨

目的探讨多层螺旋CT静脉血管造影的应用价值.方法收集不同部位CT静脉血管造影21例,颈静脉及门静脉系统血管造影由上肢静脉注入对比剂,下腔静脉及下肢造影由小隐静脉注入对比剂,行三维重建及多平面重建,结合临床资料分析血管成像技术及诊断价值.结果静脉血管CT造影表现不同于动脉CT造影,不同部位的静脉血管表现不同.21例中发现颈鼻咽癌侵犯血管1例,血管走行纡曲1例;下腔静脉瘤1例,肿瘤压迫下腔静脉1例;门静脉高压1例,疑肠系膜上静脉内血栓1例;11例下肢静脉血栓.结论不同部位的静脉影像表现存在差异,不同的重建技术对血管的显示有影响.下腔静脉造影应注意假象的存在.     

Antihypertensive drugs and catecholamine metabolism: effects of reserpine and hydralazine on tyrosine hydroxylase activity and norepinephrine concentrations in the spontaneously hypertensive rat.

The antihypertensive drugs, reserpine and hydralazine, produce different effects on tyrosine hydroxylase activity and norepinephrine levels in blood vessels and other tissues of the spontaneously hypertensive rat at doses which cause an equivalent reduction in blood pressure. Reserpine administration is associated with increased tyrosine hydroxylase activity in the mesenteric artery, mesenteric vein and adrenal, but the vasculature appears more sensitive to the effects of reserpine than the adrenal. This increase in tyrosine hydroxylase activity can be related to catecholamine depletion in the mesenteric artery, mesenteric vein and adrenal. Since chlorisondamine, a ganglionic blocking agent, diminished the ability of reserpine to increase tyrosine hydroxylase activity in the mesenteric artery and adrenal, it is likely that increased nerve activity is involved in regulation of the enzyme in both tissues. Hydralazine neither alters tyrosine hydroxylase activity in arteries or veins, nor depletes catecholamine levels in these tissues. In the adrenal, hydralazine increases tyrosine hydroxylase activity independently of any change in catecholamine levels. It would appear that changes in tyrosine hydroxylase activity produced by antihypertensive drugs are organ dependent and may involve both neuronal activity and amine depletion.