下腔静脉膜性阻塞患者肝右静脉与下腔静脉夹角关系的磁共振静脉血管成像研究

MRV comparison of the angle between the right hepatic vein and the inferior vena cava for patients with membranous obstruction of the inferior vena cava

目的 观察下腔静脉膜性阻塞型（MOVC）患者肝右静脉（RHV）与下腔静脉间夹角值,比较MOVC患者RHV的形态与健康正常对照、肝硬化患者之间的差异,指导介入治疗方案制定.方法 共搜集病例248例,依序分3组：A组（健康对照）94例;B组（MOVC患者）68例;C组（肝硬化患者）86例,分别测量其RHV与下腔静脉间夹角值（T）并按肝右静脉形态分为N、U、I三型,比较三组间T值及夹角类型的构成比有无差异,计量资料以x±s表示,组间比较采用单因素方差分析;计数资料以相对数表示,组间比较采用x2检验.结果 B组RHV与下腔静脉间夹角T值为56.1±13.7明显高于A组的49.3±7.8和C组的51.5±10.0,差异有统计学意义（F=8.750,P＜0.001）;A组和C组比较,P＞0.05,差异无统计学意义.B组N型发生率为48.5％ （33/68）,大于A组的16.0％ （15/94）和C组的16.3％ （14/86）,B组分别与A组和C组比较,x2值分别为20.1、18.6,P值均＜0.01,差异均有统计学意义.而B组U型发生率为11.8％ （8/68）小于A组的28.7％（27/94）和C组的37.2％ （32/86）,B组分别与A组和C组比较,x2值分别为6.70、12.8,P值均＜0.01,差异均有统计学意义.A、C组间N型、U型构成比差异无统计学意义（P值均＞0.05）. 结论 MOVC患者RHV与下腔静脉间夹角类型与健康正常对照存在形态学差异,且MOVC患者夹角值大,肝硬化组与健康正常对照比较,夹角间差异没有统计学意义.

Objective To determine whether there are differences in both the right hepatic vein （RHV） morphology and the size of the angle between the inferior vena cava and the RHV in patients with membranous obstruction of the inferior vena cava （MOVC）,in healthy individuals and in patients with cinhosis （HLC）,in order to help guide development of an effective interventional treatment program.Methods Consecutive patients （n =248） were divided into the following three groups：group A （control; n =94）,group B （MOVC patients; n =68）,group C （HLC patients; n =86）.The angle between the hepatic vein and inferior vena cava was measured and defined as the T value.The morphology of the RHV was classified as N,U,or I.The difference of the constituent ratio was compared among the three groups for the T value and the angle type.Measurement data was calculated as x±s,and groups were compared using one-way ANOVA; count data was calculated as relative number,and groups were compared using the chi-square test.Results The average T value of group B was significantly higher than that of group A （56.1 ± 13.7 vs.49.3±7.8,P =0.010） and of group C （vs.51.5±10.0,P 〈 0.001）; the difference was statistically significant （F =8.750,P 〈 0.001）,but there was no significant difference between the groups A and C.N-type proportion of B group was 48.5%（33/68）,greater than that of group A（16.0%,15/94）and C （16.3%,14/86）,x 2 =20.1,x 2 =18.6.U-type proportion of B group was 11.8%（8/68）,smaller than that of groups A （28.7%,27/94） and C （37.2%,32/86）,2 2 =6.70,x 2 =12.8,and the differences were statistically significant （P 〈 0.01）.For groups A and C,the N and U types were not significantly different.Conclusion The angle between the RHV and the inferior vena cava in MOVC patients is morphologically different from that in healthy humans,with the angle value in MOVC patients being slightly larger.However,this difference is irrelevant to cirrhosis.