Budd—Chiari综合征梗阻肝静脉血液引流的超声分型探讨

Sonographic classification of blood-drainage in Budd-Chiari syndrome with hepatic vein obstruction

目的 对Budd—Chiari综合征（Budd—Chiari syndrome，BCS）肝静脉阻塞时的血液引流途径进行分型以指导临床治疗。方法详细观察185例BCS患者的肝静脉病变状况，引流静脉的数量、走行以及上述静脉的血流动力学指标，并结合血管造影（DSA）和CT血管成像（CTA）表现对梗阻肝静脉的引流方式进行分型。结果185例患者中，病变肝静脉490支。其引流方式分为6型，分别为肝静脉-副肝静脉引流型（119例），肝静脉-肝静脉引流型（31例），肝静脉-副肝静脉＋肝静脉引流型（14例），腔-肝-房引流型（9例），肝静脉-脐静脉引流型（5例）和肝静脉-肝被膜下静脉引流型（7例）。上述6型梗阻肝静脉均通过数量不等、内径不同的交通支经引流静脉引流入下腔静脉、右心房、脐静脉或被膜下肝静脉，并各具相应血流动力学改变。结论超声检查对BCS梗阻肝静脉血液引流分型有助于指导临床采取正确术式进行治疗。

Objective To summarize sonographic classification of blood-drainage in Budd-Chiari syndrome （BCS） with hepatic vein（HV） obstruction in order to provide much information for clinical treatment. Methods A total of 185 patients with HV obstruction were underwent sonographic examination. The affection of HV, the courses,orifices, blood flow direction of drainage viens, the communicating branches among HVs and draining viens were observed detailedly. Classification of blood-drainage pattern were performed by sonogram in accordance with digital subtraction angiography（DSA） and computed tomography angiography（CTA）. Results There were 490 HVs with affection in 185 patients. The blood drainage pattern were classified as the following six types： HV accessory HV（AHV） type（l19/185）,HV-HV type（31/185）,HV-AHV/HV type（ 14/185）,inferior caval vein （IVC）-AHV-HV-right atrium type（9/185）, HV-umbilical vein type（5/185）and HV-hepatic subcapsular vein type （7/185）. Blood of obstructed HVs was drainaged to IVC, right atrium, umbilical veins or hepatic subcapsular veins through communicating branches which were in various amount and diameter. Haemodynamics was obtained from drainage veins correspondingly. Conclusions Sonographic classification of blood-drainage pattern in BCS with hepatic vein obstruction is of important clinical significance in the treatment.