Budd-Chiari综合征侧支循环的血管造影表现

Angiographic manifestations of collateral circulation in Budd Chiari syndrome

目的探讨ＢｕｄｄＣｈｉａｒｉ综合征（ＢＣＳ）侧支循环的血管造影表现及与介入治疗的关系。方法回顾性分析了３０例ＢＣＳ的血管造影表现，有膜性狭窄闭塞２２例，节段狭窄闭塞８例，病程４个月至２５年。行下腔静脉和楔嵌肝静脉造影。结果侧支循环分为肝内侧支、肝外侧支及肝内外侧支。肝内侧支有：（１）肝静脉藉包膜下侧支与体循环交通；（２）肝内叶间交通；（３）未确定型。肝外侧支有：（１）腰升静脉－奇静脉及半奇静脉通道；（２）腹壁浅静脉通道；（３）左肾静脉－半奇静脉通道；（４）左肾静脉－膈下静脉通道；（５）门静脉途径。结论侧支循环的解剖学变化取决于阻塞的部位。

Purpose To study the angiographic manifestations of collateral circulation in Budd Chiari syndrome(BCS) for proper interventional treatment. Methods The appearances of 30 cases of BCS with collateral circulation from 4 months to 25 years after the onset of symptoms were studied and analyzed including membranous type ( n =22) and segmental( n =8) narrowing or obstructionof the inferior vena cava proved by inferior venacavography and hepatic wedgevenography. Results The collaterals may be classified as intrahepatic,extrahepatic collateral,or both.Intrahepatic collateral included: (1) the collaterals developed through the liver capsule toward systemic venous vessel; ( 2) intrahepatic interlobar; ( 3) indeterminate type. Extrahepatic collateral included: (1)ascending lumbar azygos/hemiazygos pathway;(2)superficial collaterals of the abdominal wall pathway;( 3) left renal hemiazygos pathway;(4)left renal inferior phrenic pathway; ( 5) portalvein pathway. Conclusion Development of collateral circulation is dependent on the level of obstruction and the length of the obstructive segment. It was stressed that the collaterals had important influence on the choice of interventional procedure andtherapeutic effect in BCS.