肝硬化胆囊壁的高频超声分型与门静脉主干及右支血流动力学的关系

目的 探讨肝硬化胆囊壁的不同分型与门静脉主干及右支血流动力学变化的关系.方法 采用高频超声联合二维及彩色超声观察肝硬化组(69例)和对照组(30名)的胆囊壁分型、厚度、门静脉主干内径(D_(pv))、门静脉主干血流速度(V_(pv))、门静脉主干血流量(Q_(pv))、门静脉右支内径(D_(rpv))、门静脉右支血流速度(V_(rpv))、门静脉右支血流量(Q_(rpv)).同时根据胆囊壁的不同分型将69例肝硬化患者分为胆囊壁不厚亚组、单纯增厚亚组和双边亚组,对比肝硬化各组与对照组以上检测指标的差异.结果 各组间胆囊壁厚度均存在差异(P<0.05);D_(pv)除胆囊壁不厚亚组与单纯增厚亚组间差异无统计学意义外,其余各组间差异均有统计学意义(P<0.01);V_(pv)仅单纯增厚亚组与对照组、双边亚组与对照组间差异有统计学意义(P<0.01);Q_(pv)在双边亚组与其余各组间差异有统计学意义(P<0.05).D_(rpv)、Q_(rpv)各组间差异均无统计学意义;V_(rpv)对照组分别与单纯增厚亚组及双边亚组间差异有统计学意义(P<0.05).肝硬化组与对照组Q_(rpv)/Q_(pv)比值差异无统计学意义(P>0.05).胆囊壁厚度与D_(pv)呈正相关(r=0.886,P<0.01).结论 肝硬化时高频超声下胆囊壁的不同分型与门静脉主干血流动力学变化关系密切,而与门静脉右支血流动力学变化无相关性;胆囊静脉回流受阻并非肝硬化门静脉高压胆囊壁变化主要的血流动力学原因,其发生可能有更内在的机制.

Relationship between gallbladder wall-typing and the main portal vein, right portal vein hemodynamics in patients with liver cirrhosis with high-frequency ultrasound

Objective To investigate the relationship between gallbladder wall-typing and the main portal vein, right portal vein hemodynamics in patients with liver cirrhosis. Methods The main portal vein, right portal vein hemodynamics and the thickness of gallbladder wall were examined in 69 patients with cirrhosis and 30 normal subjects (control group) with two-dimensional ultrasound, color Doppler ultrasound and high-frequency ultrasound. According to the gallbladder wall-typing, 69 patients with liver cirrhosis were divided into "not thickened", "simple thickening" and "bilateral" subgroups. The paremeters of hemodynamics and the thickness of gallbladder wall were compared among groups. Results There was statistical difference in thickness of gallbladder wall among all 3 subgroups. Statistical difference of the diameter of main portal vein (D_pv) was found among the subgroups (P<0.01), except between "not thickened" and "simple thickening" subgroup. Statistical difference of the velocity of the main portal vein (V_pv) was found between "simple thickening subgroup" and control group, as well as between "bilateral subgroup" and the control group (P<0.01). Statistical differences of quantity of blood flow in the main portal vein (Q_pv) were detected between "bilateral subgroup" and other 2 subgroups and control group (P<0.05). No statistical difference of diameter of right portal vein (D_rpv) and quantity of blood flow in the right portal vein (Q_rpv) was found among all groups and subgroups. The velocity of the right portal vein (V_rpv) of "bilateral subgroup" was statistically different with that of the control group and the "simple thickening subgroup" (P<0.05). No statistical difference of Q_rpv/Q_pv existed between the patients with liver cirrhosis and the normal subjects (P>0.05). There was positive correlation between the gallbladder wall thickness and D_pv (r=0.886, P<0.01). Conclusion The gallbladder wall-typing has no correlation with the right portal vein hemodynamics, but is related with the main portal vein hemodynamics. The bilateral and the thickness of gallbladder wall can indirectly reflect the hemodynamic changes of main portal vein. Obstruction to flow of cystic vein is not the main hemodynamic cause for the gallbladder wall changes in patients with liver cirrhosis and portal hypertension cause, indicating that there may be some intrinsic mechanisms of this phenomenon.