布加综合征血管病变的彩色多普勒超声研究

目的:研究布加综合征患者肝静脉和下腔静脉血管形态病变和血流动力学变化,探讨彩色多普勒超声诊断布加综合征的价值。方法:彩色多普勒超声检查84例布加综合征,均经介入手术或下腔静脉造影证实。重点观察3支肝静脉和下腔静脉的走行、内径、人口、血流方向、血流频谱和流速,并追踪扩张的肝小静脉和肝内外交通支的血流方向。结果:布加综合征患者血管病变复杂多样。本组患者均合并下腔静脉病变,血管病变类型主要为短段性狭窄、短段性闭塞、长段性狭窄、长段性闭塞,左、中、右肝静脉合并受累者分别为62、75、71例(分别占总病例数的73.8%、89.3%和84.5%)。肝内外均见不同类型的交通支,并见代偿扩张的肝右后下静脉和尾叶静脉,均引流血液进入下腔静脉,肝外交通支主要为腹膜后、膈下、脾肾之间交通支以及脐旁静脉重开。结论:彩色多普勒超声可以提供布加综合征血管病变形态和血流动力学的详细资料,对诊断、分型和手术方案制定均有价值,且无创、价廉,应成为布加综合征的首选影像检查技术。

Study of vessel impairments in patients with Budd-Chiari syndrome by color Doppler ultrasound

Objective：To evaluate the diagnostic value of color Doppler ultrasound for assessing the vessel impairments and the hemodynamie changes of three main hepatic veins （including right, middle and left hepatic veins） and the inferior vena cava （IVC） in patients with Budd-Chiari syndrome （BCS）. Methods： By using color Doppler ultrasound, 84 patients with BCS clinically proved by interventional treatment or by venograms were examined. The course, diameter, orifice, flow direction as well as Doppler waveform and velocity of the three main hepatic veins and IVC were mainly investigated. The dilated small hepatic veins and collaterals were also assessed. Results： The vascular impairments were intricate in BCS. All patients had IVC impairments, which could be divided into several subtypes such as short-segmental stenosis and occlusion, long-segmental stenosis and occlusion. And right, middle and left hepatic vein impairments were found .in 62,75 and 71 cases respectively（73.8%, 89.3% and 84.5%）. Several intra-and extra-hepatic collaterals were demonstrated, draining blood from obstructed vessels to patent or relatively less narrowing vessels. Inferior right hepatic veins and caudate lobe veins were also demonstrated, draining blood directly into IVC. Other collaterals were also observed, such as retroperitoneal collaterals, sub- and trans-phrenic collaterals, spleno-renal collaterals and recanalization of paraumbilical veins. Conclusion： Color Doppler ultrasound can give valuable morphic and hemodynamic evaluation for patients with BCS. This imaging modality benefits the diagnosis, subtype classification and interventional decision-making for patients with BCS. Ultrasound examination is a noninvasive, inexpensive method and should be deserved as a first imaging choice in patients with suspected BCS.