三维超声彩色能量多普勒血管成像在Budd-Chiari综合征肝静脉病变中的应用研究  

Application of Three Dimensional Color Power Angiography in Hepatic Vein of Budd-Chiari Syndrome

作　　者：盖永浩[1] 

机构地区：[1]临沂市人民医院超声科,山东省临沂市276003

出　　处：《中国超声医学杂志》2010年第10期918-921,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨三维超声彩色能量多普勒血管成像(three dimensional color power angiography,3D-CPA)在布加综合征(Budd-chiari syndrome,BCS)肝静脉病变中的临床应用价值。方法对66例BCS患者进行肝静脉彩色能量多普勒血管三维重建,评价肝静脉的引流及肝内交通支状况。结果本组66例BCS中,共发现病变肝静脉152支。其中左肝静脉入口处隔膜样闭塞5支,入口处狭窄3支,近端节段性闭塞(闭塞长度大于1cm)29支;中肝静脉入口处隔膜样闭塞3支,入口处狭窄1支,近端节段性闭塞37支;右肝静脉入口处狭窄2支,近端节段性闭塞7支。左、中肝静脉合干后近端节段性闭塞5例共10支,合干后入口处隔膜样闭塞和入口处狭窄各2例共8支。3D-CPA清楚显示了上述62例病变肝静脉闭塞部位及肝静脉间交通支状况。右后下肝静脉引流36例43支,右后上肝静脉引流1例1支,尾叶静脉引流46例75支,右肝静脉引流9例9支,左肝静脉引流3例3支(指肝内大量交通支汇入以上静脉,通过以上静脉引流入下腔静脉)。3D-CPA均清楚显示了引流肝静脉、右后下、右后上肝静脉、尾叶静脉、肝内交通支分布状况及二、三肝门解剖结构。5例肝肿大明显,二维超声3支主肝静脉显示不清者,3D-CPA显示了肝内走行僵直的细小引流静脉;32例右肝静脉呈条索状闭塞,3D-CPA均未显示管腔内血流信号。3D-CPA还清晰显示了感兴趣区内肝门静脉与肝静脉间的立体交叉关系。结论 3D-CPA在BCS的应用更直观显示了肝静脉解剖状况与病变特征,对临床制定治疗方案提供了更为丰富的信息。Objective To investigate the clinical value of three dimensional color power angiography（3D-CPA）in hepatic vein of Budd-chiari syndrome（BCS）. Methods Sixty-six cases of BCS were studied using 3D-CPA technique and the structures of hepatic veins and communicating branches were demonstrated meanwhile. Results There were 152 affected hepatic veins in this group. Among them, septal and segmental obstruction of left hepatic veins（LHVs） were in 5 and 29 respectively,of middle hepatic veins（MI-lVs）in 3 and 37 respectively. Segmental obstruction of right hepatic veins（RHVs）were in 7. Inlet stonosis of LHVs,MHVs and RHVs were in 3,1 and 2 respectively. Septal obstruction,segmental obstruction and inlet-stonosis also appeared in 10 rami of 5 cases,2 rami of 4 cases,2 rami of 4 cases respectively after confluence of left and middle hepatic veins. Occlusive parts and communicating branches of hepatic veins in 62 cases were displayed distinctly on 3D-CPA imaging. Blood drainaged by inferier right hepatic veins, caudal-lobe veins,RHVs and LHVs were in 43 rami of 36 cases, 75 rami of 46 cases,9 rami of 9 cases,3 rami of 3 cases respectively and superier right hepatic vein was 1 ramus of 1 case. All of the drainaging and accessory hepatic veins,the communicating branches of hepatic veins ,the anatomic structure of the 2nd and 3rd porta hepatis were displayed clear ly in 3D-CPA imaging. Only stiff and tiny drainaging veins were demonstrated in 5 intumescent livers whereas not showed in 2 diamentional ultrasonogram. There was no blood signal in 32 complete obstruct RHVs. The spatial relationship among hepatic portal veins and hepatic veins was also definitely displayed in region of interest. Conclusions The anatomic structures and affected features of hepatic veins are exhibited more directly in 3D-CPA imagings which provide more information to treat BCS before operation.

关 键 词：BUDD-CHIARI综合征 彩色能量多普勒 临床应用价值 肝静脉病变 血管成像 三维超声 3D-CPA 闭塞部位 

分 类 号：R445.1[医药卫生—影像医学与核医学] R575[医药卫生—诊断学]