原发性肝癌伴布加综合征的影像学研究

Comparative study of imaging diagnosis and interventional treatment for the primary hepatocellular carcinoma with Budd-Chiari syndrome

目的:比较原发性肝癌合并布加综合征(BCS)的多种影像诊断价值。方法:回顾性分析原发性肝癌合并BCS者42例,所有患者均行超声和CT检查,18例行MRI检查,17例行肝动脉造影,9例行下腔静脉造影。7例行下腔静脉内介入治疗。结果:42例均通过超声、CT、MRI和血管造影几种影像学检查相互印证而确诊,其中下腔静脉癌栓者36例,下腔静脉狭窄者6例。7例原发性肝癌合并BCS者成功地施行了下腔静脉内介入治疗,腔静脉压力阶差由术前的(2.5±1.2)kPa降为(0.8±0.2)kPa。术后患者症状明显缓解,无严重并发症发生。结论:超声、CT、MRI和血管造影对原发性肝癌合并BCS有较高的诊断价值,相互补充有助于本病的正确诊断。血管内介入治疗是原发性肝癌合并BCS的有效治疗方法。

Objective： To compare the value of different imaging diagnosis for the primary hepatocellular carcinoma （ PHC ） with Budd - chiari syndrome （BCS）. Methods： Forty - two patients with PHC with BCS （28 men, 14 woman; aged 21 -62; average age,38.5 ± 16） were analyzed retrospectively. The sonography and computed tomography were performed in all cases, magnetic resonance imaging in 18 cases, hepatic arteriography in 17 cases and inferior vena cavography in 9 cases. Interventional intravaseular treatment was preformed in 7 cases. Results： In the 42 cases, the correct diagnoses were obtained through the sonography, computed tomography, magnetic resonance imaging and angi- ography. The tumor thrombus in the inferior vena cava were found in 36 cases, and the inferior vena cava stenosis in 6 cases. Successful interventional intravascular treatment was done in 7 cases. The pressure gradient in the inferior vena cava dropped from （ 2.5 ± 1.2 ） kPa to （ 0.8 ± 0.2 ） kPa. The symptomes disappeared or markedly improved, no serious complications. Conclusion： Sonography, computed tomography, magnetic resonance imaging and angiography have superior diagnostic value for the PHC with BCS, and they are complementary in diagnosis. Interventional intravascular treatment is a safe and effective treatment for the PHC with BCS.