摘要
目的探讨副肝静脉(AHV)在布加综合征(BCS)患者中的临床意义。方法选取徐州医科大学附属医院介入放射科2017年9月至2020年3月收治的新发BCS患者153例,作为实验组。同时随机抽取同期徐州医科大学附属医院体检中心体检的50例行肝静脉(HV)及下腔静脉(IVC)彩色多普勒超声(CDUS)检查的健康成人资料为对照组,统计分析两组患者HV及IVC的CDUS检查结果,其中实验组患者HV和(或)IVC损伤的部位及程度均由数字减影血管造影(DSA)证实;分析实验组患者不同亚组间肝功能Child-Pugh分级和手术前后HV压力变化。实验组中有粗大AHV(直径≥5 mm)的患者根据开口是否通畅分为A组和B组,A组特征为AHV开口通畅,B组特征为有粗大AHV,但开口阻塞。正态分布的定量资料用均数±标准差(■±s)表示,采用独立样本t检验或配对样本t检验;定性资料和构成比资料采用百分比表示,两组之间比较采用卡方检验;所有P值均表示双侧概率,检验水准ɑ=0.05。结果实验组中存在AHV患者的比例、存在粗大AHV患者的比例及粗大AHV的直径均高于对照组,两组间的差异有统计学意义(P<0.05)。实验组中A组和B组患者的肝功能Child-Pugh(B+C)级比例分别为4.55%(4/88)和78.57%(11/14),差异有统计学意义(P<0.001)。有粗大AHV患者中,其中A组88例皆合并IVC阻塞患者均开通IVC治疗,临床有效率为100%。术前和术后IVC压力分别为(39.43±7.33)cm H2O和(17.87±3.33)cm H2O,差异有统计学意义(P<0.001);B组三支HV及AHV全部阻塞,其中6例仅开通阻塞AHV,8例仅开通阻塞的HV,5例联合开通阻塞的IVC,术前和术后HV(包括AHV)压力分别为(43.51±3.43)cm H2O和(22.08±3.58)cm H2O,差异有统计学意义(P<0.001)。结论BCS患者中超声检出AHV比例高于健康成人,且有粗大AHV所占比例更高,此由AHV代偿增粗所致。BCS中开口通畅粗大AHV的存在,可有效缓解肝淤血造成的肝功能损伤。对于合并IVC阻塞患者,如存在开口通畅、粗大AHV,仅需开通IVC即可获得满意的临床效果。开通阻塞的粗大AHV是BCS介入治疗的有效途径之一。
Objective To investigate the clinical significance of Accessory hepatic vein(AHV)in patients with Budd-Chiari syndrome(BCS).Methods A total of 153 emerging primary BCS patients who were admitted to Affiliated Hospital of Xuzhou Medical University from September 2017 to March 2020 were enrolled in this study.There were 153 patients in the experimental group.The healthy adult data of 50 cases under Hepatic vein(HV)and Inferior vena cava(IVC)color Doppler ultrasonography(CDUS)in the physical examination center of Affiliated Hospital of Xuzhou Medical University were randomly selected as the control group.The results of HV and IVC color Doppler ultrasonography(CDUS)were analyzed statistically.The location and extent of HV and(or)IVC injury in the experimental group were analyzed by digital subtraction angiography(DSA).Liver function Child-Pugh level and HV pressure change before and after operation were studied in the experimental group.In the experimental group,patients with thick AHV(diameter≥5 mm)were divided into group A and group B according to whether the opening was smooth.The pathological features of group A were smooth and the group B was characterized by thick AHV but blocked.The quantitative data of the normal distribution are expressed as the mean±standard deviation,using the independent sample t test or the paired sample t test.The data and a data of constituent ratio were expressed as the percentage,and the two groups are compared with the chi-square test,all P values indicate bilateral probabilities,test levelsɑ=0.05.Results The proportion of patients with AHV,the proportion of patients with coarse AHV and the diameter of coarse AHV in the experimental group were higher than those in the control group,and the difference between the two groups was statistically significant(P<0.05).In the experimental group,the proportion of liver function Child-Pugh(B+C)in group A and group B was 4.55%(4/88)and 78.57%(11/14),respectively,and the difference was statistically significant(P<0.001).Among patients with massive AHV,88 patients in Group A with IVC obstruction were treated with IVC,and the clinical effective rate was 100%.Preoperative and postoperative IVC pressures were(39.43±7.33)cm H2 O and(17.87±3.33)cm H2 O,respectively,and the difference was statistically significant(P<0.001).In group B,all three HVs and AHV were obstructed,among which 6 cases were only obstructed AHV,8 cases were only obstructed HV,and 5 cases were combined with obstructed IVC.Preoperative and postoperative HV pressures(including AHV)were(43.51±3.43)cm H2O and(22.08±3.58)cm H2O,respectively,and the difference was statistically significant(P<0.001).Conclusion AHV ratio with ultrasound in BCS patients higher than healthy adults,and large AHV in diameter had a higher proportion,which is due to AHV compensatory.AHV with large and opening in BCS patients can help to alleviate the degree of hepatic congestion caused by liver congestion.For patients with BCS,if there is a AHV with large and opening,it will achieve satisfactory clinical results by the obstructed IVC to be recanalized.The blocked AHV to be recanalized is one of the effective ways of interventional therapy in BCS.
作者
许森
徐浩
王仲恺
徐文杰
崔艳峰
高志康
神斌
XU Sen;XU Hao;WANG Zhongkai(Department of Interventional Radiology,The Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu Province 221006,P.R.China)
出处
《临床放射学杂志》
北大核心
2021年第10期1988-1992,共5页
Journal of Clinical Radiology
关键词
布加综合征
副肝静脉
肝静脉
肝内交通支
Budd-Chiari syndrome
Accessory hepatic vein
Hepatic vein
Intrahepatic collaterals
