布-加综合征介入治疗术后血流动力学变化的评估

目的 探讨布-加综合征(BCS)介入治疗后形态学及血流动力学变化的特点。方法 应用二维超声及彩色多普勒血流显像检测30例正常人和256例BCS患者介入治疗前后下腔静脉及肝脾形态及血流动力学参数。结果 ①形态学变化:与对照组相比,患者介入治疗前,肝脾增大(P<0.005),肝尾状叶增大尤其明显(P<0.001);介入治疗后,治疗1周时肝脾较治疗前减小(P<0.005),与对照组相比脾脏仍较大(P<0.005);介入治疗后6月脾脏仍大于对照组(P<0.005)。②血流动力学变化:与对照组相比,下腔静脉狭窄者可见局部高速血流,阻塞者局部无血流信号,肝静脉扩张,血流减慢,并可见肝内侧枝血管,门静脉入肝血流速度减慢;介入治疗后,下腔静脉病变处增宽(P<0.005),血流恢复,并可见支架回声,肝静脉及门静脉血流速度加快(P<0.005)。结论 介入治疗解除了BCS患者肝脏血液回流受阻,改善了其血流动力学状态。

Assessment of hemodynamics in patients with Budd-Chiari syndrome after interventional treatment

Objective To study the changes in morphology of liver and spleen and hemodynamics of the patients with Budd-Chiari syndrome (BCS) after interventional treatment.Methods The dimensions of liver and spleen were detected by routine ultrsonography in 30 normal control subjects and 256 BCS patients before and after inventional therapy.Color duplex sonography was employed to measure the hemodynamic changes.Results Compared with the control group,BCS patients before interventional therapy showed obvious liver and spleen enlargements (P<0.005),specially the caudate lobe of the liver (P<0.001),which were significantly reduced 7 days after interventional treatment (P<0.005),but the spleen was still larger than that of the control group (P<0.005) even till 6 months after the therapy.Color Doppler flow imaging (CDFI) revealed local high-speed blood flow in patients with stenosis of the inferior vena cave (IVC),but color flow was not detected in patients with IVC obstruction,who had hepatic vein dilation (P<0.005) with slowed blood flow and collateral formation of in the liver,as well as decreased velocity of blood flow in the portal vein.After interventional treatment,the diameter of the involved IVC increased with blood flow restoration and the size and shape of the stent were detected clearly.The velocity of blood flow was increased in both the hepatic and portal veins (P<0.005).Conclusion Interventional therapy can relieve obstruction of blood flow in the liver and improve the hemodynamics of patients with BCS.