Budd—Chiari综合征下腔静脉超声检查方法及病变分型再探讨  

Further study of sonographic examination skills and classifications of the inferior vena cava lesions in patients with Budd-Chiari syndrome

作　　者：盖永浩[1] 马爽[2] 郭文彬[1] 梁波[1] 贾涛[1] 张素珍[1] 赵建中[3] 

机构地区：[1]山东大学附属省立医院超声诊疗科,济南250021 [2]济南市第五人民医院超声科 [3]临沂市人民医院超声科

出　　处：《中华超声影像学杂志》2012年第11期965-968,共4页Chinese Journal of Ultrasonography

摘　　要：目的探讨超声检查布-加综合征（Budd—Chiari syndrome，BCS）下腔静脉病变的方法并进行分型诊断。方法常规经腹和应用心脏探头经胸右心房下腔静脉入口切面详细观察300例BCS患者下腔静脉的二维及血流声像图特征，并对其中277例存在病变者进行分型。所有病例均经数字血管减影（DSA）证实。其中52例行CT血管成像（CTA）检查。结果下腔静脉病变分为隔膜性病变、节段性病变以及外压性病变三大类。①隔膜性病变（病变厚度≤15mm）：分为隔膜狭窄和隔膜闭塞。隔膜狭窄型根据隔膜厚度又进一步分为薄隔膜狭窄型（厚度≤5mm）和厚隔膜狭窄型（5mm％厚度≤15mm）；隔膜闭塞型则分为薄隔膜闭塞型（厚度≤5mm）和厚隔膜闭塞型（5mm〈厚度≤15mm）。②节段性病变（病变长度〉15mm）：分为节段狭窄和节段闭塞。节段狭窄型又分为长节段狭窄型（〉30mm）和短节段狭窄型（15mm％狭窄长度≤30mm）；节段闭塞型进一步分为长节段闭塞型（闭塞长度〉20mm）和短节段闭塞型（15mm（闭塞长度≤20mm）。③外压性病变：主要为肿大肝尾状叶压迫所致的下腔静脉狭窄。各型均具相应超声表现。结论经腹和应用心脏探头经胸右心房下腔静脉入口切面超声检查能对BCS患者下腔静脉病变准确分型，有助于指导临床治疗。Objective To explore a compatible approach to detect and classify the lesions of inferior vena cavas （IVCs） on sonogram in patients with Budd-Chiari syndrome（BCS）. Methods Ultrasonogram of the IVCs were observed detailedly in 300 patients with BCS by using trans abdomen and trans-thorax-right atrium- inferior vena cava ingress sections. Transducers usually used for heart examination were applied in the latter. Lesions of the IVCs found in 277 out of 300 patients were classified. All lesions were confirmed by digital subtraction angiography （DSA） and among them, 52 cases underwent computed tomography angiography （CTA）. Results Lesions of IVCs were classified into 3 categories as follows： membranous type, segmental type, and ex-pressed type. （1） Membranous type （thickness 415 mm） included membranous stenosis type and membranous occlusion type. On the basis of the thickness, the membranous stenosis type was further classified into thinner membranous stenosis type （thickness 45 mm） and thicker membranous stenosis type （5 mm〈thickness≤415 mm）. The membranous occlusion type was further classified into thinner membranous occlusion type （thickness 45 mm） and thicker membranous occlusion type （5 mm〈 thickness 415 ram）. （2） Segmental type （length 〉15 mm） was consist of segmental stenosis type and segmental occlusion type. Based on the length of the lesion,the segmental stenosis type was further divided into longer segmental stenosis type （length 〉30 mm） and shorter segmental stenosis type （15 mm〈 length 430 mm）. The segmental occlusion type was further divided into longer segmental occlusion type （length〉 20mm） and shorter segmental occlusion type （15 mm〈length ≤420 mm）. （3） Ex-pressed type of IVCs was mainly caused by compression of intumescent caudate lobes. Corresponding sonographic features were demonstrated in each type. Conclusions Uhrasonogram of trans-abdomen and trans-thorax-right atrium- inferior vena cava ingress sections cou

关 键 词：超声检查 肝静脉血栓形成 腔静脉 下 

分 类 号：R445.1[医药卫生—影像医学与核医学]