肝肺综合征的肺部CT和DSA表现及其病理基础

The pulmonary manifestation of hepatopulmonary syndrome presented by CT and DSA based on pathologic changes

目的 探讨肝肺综合征 (HPS)的肺部CT和DSA表现特点、病理基础以及两者间的对应关系。方法 成年杂种犬 14只 ,随机分为实验组和对照组。前组腹腔注射 99.5 %CCl4,后组注射生理盐水 (0 .5ml/kg体重 ) ,每周 1次 ,共 10周。此后摄胸部平片 ,行胸部CT扫描和肺动脉DSA ,作肝功能检测和血气分析。处死后行肝、肺病理切片。结果 1.胸部平片表现为中下肺网格状结节阴影 ;2 .CT表现为肺小血管杵状或蜂窝状扩张 ;3.DSA表现肺毛细血管“海绵”状扩张以及肺小动脉柱状或杵状扩张 ;4 .PaO2 愈低 ,肺部损害愈重 ;5 .病理切片可见肺小血管扩张、中膜增厚。结论 1.X线平片对于HPS肺部损害的诊断无特异性 ;2 .CT和DSA检查具有重要诊断价值 ;3.PaO2 检测可以评估病变的严重程度 ,4 .HPS患者肺部损害的病理基础是肺小血管扩张、中膜增厚。

Objective To investigate the CT and DSA manifestations and pathologic changes of lung injuries caused by hepatopulmonary syndrome(HPS) and correlate the relationship between them. Methods 14 canine were randomly divided into experimental group and control group ( n =7). The former was injected with CCl 4 into the abdominal cavity, and the later was injected with saline, 0.5ml/kg.bw, 1 time qw, till 10th week. CT scanning of the chest and digital subtraction angiography of lung artery were made. The assay of PaO 2 was taken. After executing, the sections of liver and lungs were taken for microscopic examination. Results ①The chest radiograms showed the reticulated nodular opacities in the middle lower lungs.② Pestle or honeycomb like dilatation of the lung micro vessels was obvious shown on CT scans.③ DSA showed sponge like dilatation of the pulmonary micro vessels extending to the pleura.④ The lungs injuries were graver in the dogs with lower PaO 2.⑤ The small arterial dilatations with medium membrance hyperplasia were found pathologically. Conclusion ①X ray plain film shows non specific characteristics for the diagnosis of lung injuries caused by HPS.② CT and DSA examination play an important diagnostic role.③ The testing of PaO 2 can reflect the severities of injuries.④ The pathologic basis of HPS lies on lung vascular dilatation with medium layes hyperplasia.