三维超声彩色能量多普勒血管成像对Budd-Chiari综合征第三肝门引流状况的评价

目的：评价三维超声彩色能量多普勒血管成像（3D—CPA）在Budd-Chiari综合征（BCS）患者第三肝门血管引流状况中的临床应用价值。方法：对60例BCS患者主肝静脉和第三肝门引流血管（包括右后下肝静脉及尾叶静脉）进行彩色能量多普勒血管三维重建，评价主肝静脉阻塞后肝内交通静脉及第三肝门血管的引流状况。结果：本组60例BCS患者共计180支主肝静脉中，病变主肝静脉139支，正常通畅主肝静脉41支。除43支完全闭塞的主肝静脉无血流信号外，3D—CPA清晰显示了，其余96支未完全闭塞的主肝静脉，通过数量不等、内径不同的肝内交通支汇入右后下肝静脉和／或尾叶静脉，然后经第三肝门引流入下腔静脉。交通支内径3-10mm。梗阻主肝静脉通过交通支经43支右后下肝静脉和71支尾叶静脉引流入下腔静脉。第二、三肝门的立体空间解剖关系显示明确。对肝静脉的闭塞部位显示血流信号消失，肝内交通支桥接于阻塞肝静脉与右后下肝静脉和／或尾叶静脉之间。结论：3D—CPA在BCS第三肝门的应用更直观显示了阻塞后肝静脉的血液引流状况，对临床制定治疗方案提供了更为丰富的信息。

Evaluation of hepatic vein drainage in the third hepatic hilum of Budd-Chiari syndrome using three dimensional color power angiography

Objective： To evaluate the clinical value of three dimensional color power angiography（3D-CPA） applied in the drainage of the third hepatic hilum in Budd-Chiari syndrome （BCS）. Methods： Sixty cases with BCS underwent 3D-CPA for demonstrating draining vessels of the third hepatic hilum including inferior right hepatic veins and caudal-lobe veins. The structures of hepatic vein and communicating branches were observed. ATL HDI 3500 was used with transducer 3.5MHz. Resuits： Ninety-six of 139 rami affected hepatic veins were not completely obstructive in this group. All of the occlusive parts and communicating branches of the 96 hepatic veins mentioned above were displayed distinctly on 3D-CPA imaging. Blood drained through inferior right hepatic veins and caudal-lobe veins were 43 and 71 rami respectively. The spatial relationship of anatomic structures of the 2nd and 3rd hepatic hilum was displayed clearly on 3D-CPA imaging. There was no blood sig- nal in the obstructive parts of the hepatic veins but blood signals replenished the communicating branches bridging from the affected hepatic veins to the inferior right hepatic and/or caudal-lobe veins. Conclusion： The anatomic structures and blood drainage state of the third hepatic hilum are visulized more directly on 3D-CPA images which provide more information for treating BCS before operation.