彩色多普勒超声在诊断与治疗肝段下腔静脉梗阻中的应用

目的 探讨应用彩色多普勒血流显像结合二维图像对肝段下腔静脉梗阻的诊断及其临床价值.方法 应用彩色多普勒对10例Budd-Chiari综合征患者的肝静脉、下腔静脉(IVC)、门静脉声像图进行分析,明确病变部位、范围及阻塞性质、程度,做出超声分型诊断,并与静脉造影对比后选择不同治疗方案.结果1.IVC节段性狭窄4例;2.隔膜状阻塞2例;3.IVC穿膈处血栓形成闭塞1例;4.IVC长段闭塞2例;5.肝硬化合并肝癌致IVC外压性狭窄1例.本组中除2例IVC长段闭塞者行腔房搭桥术及1例合并肝癌者未做手术外,余7例患者分别采取局麻下IVC内球囊扩张术并Z型支架植入术及局部抗凝溶栓治疗.结论 彩色多普勒能清晰显示血管管腔及血流情况,做出明确的超声分型诊断从而对外科手术方式的选择,判断术后效果有重要意义.其无创的可重复性及诊断价值可取代或部分取代有创的静脉造影.

The application of Color Doppler Flow Imaging in the Diagnosis and Treatment of Budd-Chiari Syndrome

Objective To evaluate the applied value of color doppler flow imaging (CDFI) and two-dimensions image in the diagnosis and clinical situation of Budd-Chiari syndrome (B-CS). Methods Ten patients with B-CS were studied hy CDFI to clarify thesite. degree, nature of obstruction and ultrasonographic classification. The results were compared with inferior cavography. Then surgical operation, or stenting was intervened. Results Five obstruction patterns were observed: 1. segmental obstruction(4 cases) 2. membranous obstruction(2 cases) 3. thrombosis (1 case) 4. long segment occlusion(2 cases) 5. extrahepatovenous compression obstruction due to hepatocirrhosis complicated with hepatocarcinoma (1 case). Except three patients, the others received stent implantation and local anticoagulant treatment. Conclusion The CDFI technique could display clearly vascular lumen and blood flow, and help to make ultrasonographic classification. It has great value in choosing surgical operations and assessing post-operation effects. CDFI would be substituted for inferior cavography because of its non-invasivness and duplicity.