Budd-Chiari综合征介入治疗前后肝脾形态及其血流动力学研究

Morphology and Hemodynamics of Liver and Spleen in Patients with Budd-Chiari Syndrome before and after Interventional Therapy

目的 探讨Budd Chiari综合征 (BCS)肝脾形态及其血流动力学改变 ;研究介入治疗对BCS肝脾形态及血流动力学的影响。方法 应用二维超声及CDFI检测 3 0例正常人 (对照组 ) ,41例BCS患者介入治疗前后肝脾形态及血流动力学指标。结果 ①介入治疗前 (术前组 )与对照组相比 :肝脾增大 (P <0 .0 1) ,尾叶显著增大 (P <0 .0 0 1) ;门静脉入肝血流速度及流量减少 (P <0 .0 1) ;肝、脾动脉血流阻力增大 (RI及S/D增大 ,P <0 .0 1)。②介入治疗后 7至 10日 (术后Ⅰ组 )与术前组及对照组相比 :肝脾较术前减小 ,与对照组相比仍大 ;门静脉入肝血流速度及流量较术前增加 ;肝、脾动脉血流阻力下降。③介入治疗后 1年 (术后Ⅱ组 )肝脾仍大于对照组。结论 BCS肝脏血液回流受阻 ,肝脾形态及血流动力学发生了相应改变 ;介入治疗解除或减轻了肝脏血液回流阻力 ,改善了肝脾血流动力学。

Objective To study the abnormal morphology and hemodynamics of liver and spleen in patients with Budd-Chiari syndrome (BCS) and to investigate the effects of interventional therapy (IT) on them.Methods The dimensions of liver and spleen were measured by routine ultrasonography in 30 normal controls and 41 cases of BCS before and after IT.Duplex color system was employed to determine the hemodynamic parameters.Results ①Compared with the control group,the BCS group before IT showed:The patients' liver and spleen were enlarged ( P <0.01),especially the caudate lobe ( P < 0.001 );The blood flow from the portal vein (PV) into the liver was subnormal in velocity and amount ( P <0.01);The resistance in hepatic artery to the right lobe (RHA) and splenetic artery (SA) was increased (RI and S/D values increased, P < 0.01 ).②Comparison between the data obtained in the control group and the BCS group (before IT and 7-10 days after IT) showed:The dimensions of patients' liver and spleen were all reduced after IT,but still bigger than those in the control group;The velocity and amount of blood flow in PV were increased after IT;S/D and RI of RHA and SA were lowered after IT.③The dimensions of patients' liver and spleen a year after IT were still bigger than those in the control group.Conclusion The morphology and hemodynamics of liver and spleen in patients with BCS greatly changed due to the retardation of the venous flow from the liver.IT can dilate the restriction and improve the hemodynamics of liver and spleen.