彩色多普勒超声在不同类型布-加综合征诊断与治疗中的价值

The value of color Doppler ultrasound in the diagnosis and treatment of different types of Budd-Chiari Syndrome

目的探讨彩色多普勒超声在不同类型布-加综合征(BCS)诊断与治疗中的价值。方法应用彩色多普勒超声对临床拟诊的不同类型BCS患者106例及30例健康对照者进行检测,观察其特异性血管形态及血流动力学变化,与DSA对比,并治疗后随访。结果(1)超声诊断BCS90例,DSA确诊89例,超声诊断的敏感性97.8%,特异性82.4%,准确性95.3%,假阳性率17.7%,假阴性率2.3%。(2)血流动力学变化:与对照组相比,下腔静脉(IVC)狭窄者可见局部高速血流,阻塞者局部无血流信号;肝静脉(HV)扩张,血流减慢,并可见肝内侧枝血管;门静脉(PV)入肝血流速度减慢.(3)介入治疗及手术后随访:①介入治疗后,IVC病变处增宽,血流恢复,并可见支架回声,HV及PV血流速度加快;②手术治疗组,根治者可见IVC及HV血流恢复正常,人工血管转流者,可见人工血管呈螺旋管状,内血流清晰。结论彩色多普勒超声对BCS的诊断与血管造影具有良好的相关性,可明确BCS特异性异常血管形态及血流动力学变化,是BCS诊断及术后随访的可靠方法。

Objective To investigate clinical value of color Doppler ultrasound in the diagnosis and treatment of different types of Budd-Chiarl Syndrome. Methods Totally, 106 patients to be suspected Budd-chiari syndrome（BCS）clinically and 30 healthy adults were examined with color Doppler ultrasound, The characteristic patterns of abnormal vessels and hemodynamics were observed, compared with DSA and followed up after interventional therapy, Results （1）Ninety cases were diagnosed by color Doppler ultrasound, in which 89 cases were confirmed by the ＂gold standard＂ DSA. The sensitivity of color Doppler ultrasound was 97.8%, specificity was 82.4%, accuracy was 95.3%, false positive rate was 17.7%, and false negative rate 2.3%. （2）When compared with the control group, color Doppler imaging showed local high-speed blood flow in patients with stenosis of the inferior vena cava（IVC）, but color flow signal was not detected in the cases with IVC obstruction, who had hepatic veins （HV）dilation with slowed blood flow and collateral flow in the liver, as well as decreased velocity of blood flow in portal vein. （3）After interventional treatment, the diameter and blood flow of the involved IVC returned normal and the size and shape of stent were detected clearly.The velocity of blood flow was increased in both the HV and portal veins. IVC and HV blood flow recovered in the cases underwent surgical operation, or graft bypass was detected in IVC with normal blood flow signals. Conclusion Color Doppler ultrasound is useful in the diagnosis of BCS, correlated well with DSA. Therefore, it can be an ideal method in the diagnosis and follow up patients with BCS.