三维DSA在腔静脉闭塞型布加综合征诊断和介入治疗中的价值  

The value of DSA in diagnosis and interventional treatment of Budd-Chiari syndrome caused by the obstruction of the inferior vena cava

作　　者：张庆桥[1] 祖茂衡[1] 徐浩[1] 顾玉明[1] 李国均[1] 魏宁[1] 许伟[1] 刘洪涛[1] 崔艳峰[1] 陈雪荣[1] 闵继忠[1] 

机构地区：[1]徐州医学院附属医院介入放射科,221002

出　　处：《中华放射学杂志》2008年第5期515-518,共4页Chinese Journal of Radiology

基　　金：国家“十一五”科技支撑计划协作基金资助项目（2006038073024）;江苏省“青蓝工程”基金资助项目[苏教师（2007）2号]

摘　　要：目的评价三维DSA（3DDSA）在腔静脉闭塞型布加综合征诊断和介入治疗中的价值。方法21例下腔静脉（IVC）闭塞情况复杂的布加综合征患者经二维DSA（2DDSA）后前位检查确诊后，加做3DDSA检查。由2名介入放射专业主任医师采用双盲法分别阅读2DDSA和3DDSA图像以评价IVC解剖结构，并采用x^2检验比较两者对血管的显示情况。根据2D和3DDSA检查结果施行IVC球囊扩张术或支架置入术。结果所有患者3DDSA均能准确显示IVC闭塞端位置、形态、侧支血管开口及其空间位置关系，检出侧支血管起源于闭塞端9例；2DDSA能显示闭塞端位置、形态、侧支血管开口及其空间关系7例，检出侧支血管起源于闭塞端2例，两者比较差异均有统计学意义（x^2值分别为12．07和5．14，P〈0．05）。仿真血管内镜成像显示IVC内游离血栓3例、附壁血栓1例。全部患者均治疗成功，1例并发IVC破裂出血，无其他并发症。结论3DDSA在IVC闭塞的诊断中能提供有价值信息，对腔静脉闭塞型布加综合征介入治疗有指导意义。Objective To investigate the value of three-dimensional digital subtraction angiography （3D-DSA） in the diagnosis and interventional treatment of Budd-Chiari syndrome caused by the obstruction of inferior vena cava （IVC）. Methods Twenty-one patients with complex Budd-Chiari syndrome caused by the obstruction of IVC underwent 3D-DSA after two-dimensional-DSA （2D-DSA） was performed with posterior-anterior view. The images of 2D-DSA and 3D-DSA were independently reviewed by two senior interventional radiologists in a double-blinded way. Percutaneous transluminal angioplasty or stent placement of IVC were performed according to the results of 2D-DSA and 3D-DSA. Results Different aspects of the IVC in all patients were demonstrated on the 3D-DSA images, including the morphology and the location of obstructions, the origins of collateral vessels and their relationships to the IVC. Collateral vessels originated from the site of IVC occlusions in 9 patients were detected by the 3D-DSA. However, the 2D-DSA provided excellent visualization of the vascular structures of the IVC in 7 patients, and the collateral vessels originated from the site of IVC occlusions were shown in 2 patients. The 3D-DSA was significantly superior to the 2D-DSA in detecting the IVC obstructions and the collateral vessels （ P 〈 0. 05 ）. The virtual angioscopy of the 3D-DSA was able to visualize free IVC thrombosis in 3 paitents, and mural IVC thrombosis in 1 patient. The procedures were successful in all patients. There were no other complications except the rupture of IVC in 1 patient. Conclusion The 3D-DSA can offer valuable informations in diagnosis of IVC obstruction, and it may play an important role in interventional treatment of Budd-Chiari syndrome.

关 键 词：血管造影术 数字减影 成像 三维 腔静脉 下 放射学 介入性 布加综合征 

分 类 号：R686[医药卫生—骨科学]