肝前门脉高压区域性血管变化的超声表现与临床
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- 英文论文题名：Ultrasound findings and clinical manifestations in patients with regional portal hypertension
- 论文作者：梁燕 ; 汤善红 ; 邓旦 ; 陶杰 ; 廖明松 ; 赖小今 ; 吴晓波
- 英文论文作者：LIANG Yan ; TANG Shanhong ; DENG Dan ; Ultrasound department of General Hospital of Chengdu Military Region ; GI Medicine of General Hospital of Chengdu Military Region
- 年：2016
- 作者机构：成都军区总医院超声科;成都军区总医院消化内科;
- 论文关键词：肝前门静脉高压 ; 区域性血管变化 ; 超声检查
- 英文论文关键词：Regional portal hypertension ; vascular changes ; ultrasonography
- 会议召开时间：2016-08-21
- 会议录名称：2016’中国西部声学学术交流会论文集
- 语种：中文
- 分类号：R445.1;R575.2
- 学会代码：SXJS
- 会议名称：2016’中国西部声学学术交流会
- 会议地点：中国四川成都
- 主办单位：中国声学学会微声学分会、中国声学学会物理声学分会、陕西省声学学会、浙江省声学学会、山东省声学学会、上海市声学学会、黑龙江省声学学会、水声技术重点实验室、重庆市声学学会、西安市声学学会、四川省声学学会
- 学会名称：《声学技术》编辑部
- 页数：4
- 文件大小：536k
- 原文格式：D
- 会议级别：全国
摘要
目的:探讨肝前门静脉高压区域性血管变化的超声表现和诊断价值。方法:回顾2012年-2016年我院消化内科确诊的肝前区域性门静脉高压患者9例门静脉区域血管异常的超声表现,观察受累血管内径、形态、血流性质及方向,分析受累血管血流频谱。结果:9例肝前区域性门静脉高压患者,彩超发现3例门静脉增宽,血流增多,流速增快并出现低阻状动脉频谱,脾静脉增宽,回流受阻,脾静脉管腔内出现絮状、不规则状或条索状低弱回声,脾静脉管腔内血流信号减少、变细或不均、血流靠边,频谱所示局部血流紊乱,流速快慢不等确定诊断;2例患者通过门静脉血管三维重建发现脾静脉栓塞后,通过超声造影确定脾静脉血栓形成,其内血流信号减少;另4例超声未发现门脉系明显异常,经其它方法检查后得以确诊。超声对本病阳性诊断率约为55.56(5/9),漏诊约44.44%(4/9)。结论:彩色多普勒超声对筛查、诊断及随访肝前区域性门静脉高压有一定价值,但受诸多因素影响,漏诊较高。仔细观查门脉系统管腔结构和内部回声,血流变化,并结合超声造影和其它影像学检查并重视临床病史,可进一步提高其发现率和准确诊断率。
Objective: To investigate the ultrasonographic features and diagnostic value of vascular changes in patients with regional portal hypertension. Methods: Nine cases with regional portal vein were observed by ultrasonography involvement of vascular diameter, morphology and flow characteristics and direction, fistula and involvement of vascular blood flow frequency spectrum analysis. Results: In nine cases with hepatic regional portal hypertension, ultrasound found 3 cases of portal vein widened, increase blood flow, flow rate increase and the emergence of low resistance artery spectrum, splenic vein dilation, venous obstruction, splenic vein lumen appeared flocculent, irregular or cords low echo, blood flow signals of spleen within the blood vessels to reduce, thin or uneven, flow speed range determined diagnosis; 2 patients through three-dimensional reconstruction of portal vein and splenic vein was found after embolization, by contrast-enhanced ultrasound to determine the splenic vein thrombosis, the reduced blood flow signal; the other 4 cases of ultrasound did not find the door the veins of abnormal, after examination to be diagnosed by other methods. The diagnosis rate of the disease was about 55.56(5/9), and 44.44%(4/9). Conclusion: Color Doppler ultrasound has a certain value in screening, diagnosis and follow-up of the regional portal hypertension, but it is influenced by many factors, and the higher of the missed diagnosis. Careful Chamen vein system lumen structure and internal echo, blood flow changes, combined with contrast enhanced ultrasound and other imaging examination and paying attention to the clinical history, can improve the detection rate and the accurate diagnostic rate.
Objective: To investigate the ultrasonographic features and diagnostic value of vascular changes in patients with regional portal hypertension. Methods: Nine cases with regional portal vein were observed by ultrasonography involvement of vascular diameter, morphology and flow characteristics and direction, fistula and involvement of vascular blood flow frequency spectrum analysis. Results: In nine cases with hepatic regional portal hypertension, ultrasound found 3 cases of portal vein widened, increase blood flow, flow rate increase and the emergence of low resistance artery spectrum, splenic vein dilation, venous obstruction, splenic vein lumen appeared flocculent, irregular or cords low echo, blood flow signals of spleen within the blood vessels to reduce, thin or uneven, flow speed range determined diagnosis; 2 patients through three-dimensional reconstruction of portal vein and splenic vein was found after embolization, by contrast-enhanced ultrasound to determine the splenic vein thrombosis, the reduced blood flow signal; the other 4 cases of ultrasound did not find the door the veins of abnormal, after examination to be diagnosed by other methods. The diagnosis rate of the disease was about 55.56(5/9), and 44.44%(4/9). Conclusion: Color Doppler ultrasound has a certain value in screening, diagnosis and follow-up of the regional portal hypertension, but it is influenced by many factors, and the higher of the missed diagnosis. Careful Chamen vein system lumen structure and internal echo, blood flow changes, combined with contrast enhanced ultrasound and other imaging examination and paying attention to the clinical history, can improve the detection rate and the accurate diagnostic rate.
引文
[1]Loftus JP,Nagorney DM,Ilstrup D,et al.Sinistral portal hypertension.Splenectomy or expectant management[J].Ann Surg,1993,217(1):35-40.
[2]Hii HP,Wu ZH,Yeh ML,Chen CC.(2009)Successful coil embolization of an unusual aorto-superior mesenteric vein fistula.J Vasc Surg 49:1310-2.
[3]Gabriel S,Maroney TP,Ringe BH.(2007)Hepatic artery-portal vein fistula formation after percutaneous liver biopsy in a living liver donor.Transplant Proc 39:1707-9.
[4]Wo?niak W,Mlosek RK,Mi?ek T,Myrcha P,Ciostek P.(2011)Splenic arteriovenous fistula--late complications of splenectomy.Acta Gastroenterol Belg 74:465-7.
[5]Sachdeva R,Yapor M,Schwersenz A,Mitty H,Norton K,et al.(1993)Massive variceal bleeding caused by a hepatic artery-portal vein fistula:a manifestation of hepatocellular carcinoma in a12-year-old.J Pediatr Gastroenterol Nutr 16:468-71.
[6]Butler JR,Eckert GJ,Zyromski NJ,et al.Natural history of pancreatitis-induced splenic vein thrombosis:a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding[J].HPB(Oxford),2011,13:839-845.
[7]7.Koklu S.Left-sided portal hypertension[J].Dig Dis Sci,52(5):1141-1149.
[8]Saugel B,Gaa J,Phillip V,et al.Splenic artery embolization in a woman with bleeding gastric varices and splenic vein thrombosis:a case report[J].J Med Case Rep,2010,4:247.
[9]Luo X,Nie L,Wang Z,et al.Transjugular endovascular recanalization of splenic vein in patients with regional portal hypertensioncomplicated by gastrointestinal bleeding.Cardiovasc Intervent Radiol.2014,37(1):108-13.
[2]Hii HP,Wu ZH,Yeh ML,Chen CC.(2009)Successful coil embolization of an unusual aorto-superior mesenteric vein fistula.J Vasc Surg 49:1310-2.
[3]Gabriel S,Maroney TP,Ringe BH.(2007)Hepatic artery-portal vein fistula formation after percutaneous liver biopsy in a living liver donor.Transplant Proc 39:1707-9.
[4]Wo?niak W,Mlosek RK,Mi?ek T,Myrcha P,Ciostek P.(2011)Splenic arteriovenous fistula--late complications of splenectomy.Acta Gastroenterol Belg 74:465-7.
[5]Sachdeva R,Yapor M,Schwersenz A,Mitty H,Norton K,et al.(1993)Massive variceal bleeding caused by a hepatic artery-portal vein fistula:a manifestation of hepatocellular carcinoma in a12-year-old.J Pediatr Gastroenterol Nutr 16:468-71.
[6]Butler JR,Eckert GJ,Zyromski NJ,et al.Natural history of pancreatitis-induced splenic vein thrombosis:a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding[J].HPB(Oxford),2011,13:839-845.
[7]7.Koklu S.Left-sided portal hypertension[J].Dig Dis Sci,52(5):1141-1149.
[8]Saugel B,Gaa J,Phillip V,et al.Splenic artery embolization in a woman with bleeding gastric varices and splenic vein thrombosis:a case report[J].J Med Case Rep,2010,4:247.
[9]Luo X,Nie L,Wang Z,et al.Transjugular endovascular recanalization of splenic vein in patients with regional portal hypertensioncomplicated by gastrointestinal bleeding.Cardiovasc Intervent Radiol.2014,37(1):108-13.