彩色多普勒超声在肝前性门静脉高压中的应用价值

The Clinical Value of Color Doppler Ultrasound for Prehepatic Portal Hypertension

目的评价彩色多普勒超声对肝前性门静脉高压的诊断价值。方法回顾2012年6月-2015年1月9例确诊为肝前性门静脉高压患者的彩色多普勒超声表现,观察受累血管内径、形态、血流性质及方向,分析瘘口及受累血管血流频谱。结果 9例患者彩色多普勒超声发现3例区域性门静脉增宽,血流增多,流速增快并出现低阻状动脉频谱,脾静脉增宽,回流受阻,脾静脉管腔内出现絮状、不规则状或条索状低弱回声,其间脾静脉管腔内血流信号减少、变细或不均、血流靠边,频谱所示局部血流紊乱,流速快慢不等;2例其他影像学方法及超声确诊脾静脉内血栓形成,其内血流信号明显减少;另4例超声未发现门脉系明显异常,经其他方法检查后得以确诊。彩色多普勒超声检查对肝前性门静脉高压的阳性诊断率为5/9,漏诊率为4/9。结论彩色多普勒超声对筛查、诊断及随访肝前性门静脉高压有一定价值,但受诸多因素影响,漏诊率较高。仔细观察门脉系统管腔结构和内部回声,血流变化,并结合其他影像学检查和重视临床病史,可进一步提高其发现率和准确诊断率。

Objective To evaluate the clinical value of color Doppler ultrasound in diagnosing prehepatic portal hypertension. Methods A retrospective analysis was performed to analyze the results of color Doppler ultrasonography in 9 patients with prehepatic portal hypertension diagnosed between June 2012 and January 2015, including vessel diameter, shape, nature and direction of blood flow, and fistula blood flow spectrum. Results Among the 9 patients, the color Doppler ultrasound found 3 patients with regional portal widened, increased and faster blood flow with the emergence of low-impedance spectrum artery, splenic vein widened with returning blocked and flocculent substance within the splenic vein lumen, irregular or streak-shaped low weak echo during splenic vein reduction, and unstable or weakened blood flow velocity. Two patients were confirmed with splenic vein thrombosis by ultrasound and other imaging methods with significantly reduced blood in splenic vein. For the other four patients with regional portal hypertension, obvious abnormalities in portal system were not detected by color Doppler ultrasound, but they were checked with other methods. The ultrasound positive diagnosis of the 9 patients was 5, with 4 missed. Conclusions The color Doppler ultrasound has some values in screening~ diagnosis and follow-up of prehepatic portal hypertension, but it can also be influenced by many factors with a high missed diagnosis rate. Carefully observing the portal system lumen structure, internal echo and blood flow combined with other imaging studies, and emphasizing clinical history of the patients can further improve diagnostic accuracy.