64层螺旋CT血管成像技术对Budd-Chiari综合征侧支循环的评价

Evaluation of collateral circulation in Budd-Chiari syndrome with CTA technique using 64-slice CT

目的:探讨64层螺旋CT血管成像(CTA)技术对Budd-Chiari综合征(BCS)侧支循环的显示价值。方法:对74例BCS病人术前行CTA检查,观察肝静脉、下腔静脉病变类型及侧支循环情况。结果:74例均诊断为混合型BCS,下腔静脉和肝静脉存在不同程度的梗阻,每一例病人均有侧支循环形成。侧支循环分为肝内侧支、肝外侧支及门静脉-体静脉交通。肝内侧支循环分为6种类型:①肝静脉-副肝静脉引流型(n=47,63.5%);②肝静脉-肝静脉引流型(n=5,6.7%);③肝静脉-副肝静脉加肝静脉引流型(n=6,8.1%);④腔-肝-房引流型(n=4,5.4%);⑤肝静脉-脐静脉引流型(n=4,5.4%);⑥肝静脉-肝被膜下静脉引流型(n=8,10.8%)。上述6型肝内侧支均通过数量不等、内径不同的交通支经引流静脉引流入肝段下腔静脉、右心房、脐静脉或被膜下肝静脉与体循环相通。肝外侧支循环分为4种类型:①腰静脉-腰升静脉-奇静脉及半奇静脉侧支型(n=74,100%);②左肾静脉-腰升静脉-半奇静脉侧支(n=74,100%)和左肾静脉-左膈下静脉侧支型(n=48,64.8%);③肾静脉-肾包膜下静脉-腹壁浅静脉侧支型(n=26,35.1%);④腹壁浅静脉侧支型(n=10,13.5%)。结论:64层螺旋CTA可无创性清晰显示BCS患者各种类型的侧支循环途径,对指导临床选择正确的治疗方案具有重要价值。

Objective： To evaluate the computed tomographic angiography（CTA） technique in the diagnosis of collateral circulation in Budd-Chiari syndrome（BCS）. Methods： Seventy-four patients with mix-type BCS were examined by CTA technique. The involved hepatic veins（HVs）, inferior vena cavas（IVCs） and collateral pathways were observed in detail. Results： Obstruc tions of HVs and IVCs were found in all the 74 patients at different level and degree, collateral pathways developed and were defined in each patient. The collaterals can be classified as intrahepatic, extrahepatic collaterals and portal vein-systemic vein communication. Intrahepatic collaterals were further classified as the following six types： ①hepatic vein （HV）-accessory hepatic vein（AHV） pathway（n=47, 63.5%）; ②HV-HV pathway（n=5, 6.7%）; ③HV-AHV/HV pathway（n=6, 8.1%）; ④inferior vein cava （IVC）-AHV-HV-right atrium pathway （n=4, 5.4%）; ⑤HV-umbilical vein pathway （n=4, 5.4%）; ⑥HV-hepatic subcapsular vein pathway（n=8, 10.8%）. Blood of obstructed HVs was drained into IVC, right atrium, umbilical veins or hepatic subcapsular veins through communicating branches which were in various amount and diameter. Extrahepatic collaterals include： ①ascending lumbarazygos/hemiazygos pathway（n=74, 100%）; ②left renal-ascending lumbarhemiazygos（n=74, 100%）/left renalinferior phrenic vein pathway （n=48, 64.8%）; ③renal vein-renal subcapsular vein-superficial collaterals of the abdominal wall pathway （n=26, 35.1%）; ④superficial abdominal wall pathway（n=10, 13.5%）. Conclusion： Collateral circulations of BCS can be demonstrated clearly and non-invasively by CTA. CTA is valuable for the guidance in choosing right therapy method.