CAJ | 학술논문

目的探讨超声检查布-加综合征(Budd-Chiari syndrome,BCS)下腔静脉病变的方法并进行分型诊断.方法常规经腹和应用心脏探头经胸右心房下腔静脉入口切面详细观察300例BCS患者下腔静脉的二维及血流声像图特征,并对其中277例存在病变者进行分型.所有病例均经数字血管减影(DSA)证实.其中52例行CT血管成像(CTA)检查.结果下腔静脉病变分为隔膜性病变、节段性病变以及外压性病变三大类.①隔膜性病变(病变厚度≤15 mm):分为隔膜狭窄和隔膜闭塞.隔膜狭窄型根据隔膜厚度又进一步分为薄隔膜狭窄型(厚度≤5 mm)和厚隔膜狭窄型(5 mm＜厚度≤15 mm)；隔膜闭塞型则分为薄隔膜闭塞型(厚度≤5 mm)和厚隔膜闭塞型(5 mm＜厚度≤15 mm).②节段性病变(病变长度＞15 mm):分为节段狭窄和节段闭塞.节段狭窄型又分为长节段狭窄型(＞30 mm)和短节段狭窄型(15mm＜狭窄长度≤30 mm)；节段闭塞型进一步分为长节段闭塞型(闭塞长度＞20 mm)和短节段闭塞型(15mm＜闭塞长度≤20 mm).③外压性病变:主要为肿大肝尾状叶压迫所致的下腔静脉狭窄.各型均具相应超声表现.结论经腹和应用心脏探头经胸右心房下腔静脉入口切面超声检查能对BCS患者下腔静脉病变准确分型,有助于指导临床治疗.
목적 탐토초성검사포-가종합정(Budd-Chiari syndrome,BCS)하강정맥병변적방법병진행분형진단.방법 상규경복화응용심장탐두경흉우심방하강정맥입구절면상세관찰300례BCS환자하강정맥적이유급혈류성상도특정,병대기중277례존재병변자진행분형.소유병례균경수자혈관감영(DSA)증실.기중52례행CT혈관성상(CTA)검사.결과 하강정맥병변분위격막성병변、절단성병변이급외압성병변삼대류.①격막성병변(병변후도≤15 mm):분위격막협착화격막폐새.격막협착형근거격막후도우진일보분위박격막협착형(후도≤5 mm)화후격막협착형(5 mm＜후도≤15 mm)；격막폐새형칙분위박격막폐새형(후도≤5 mm)화후격막폐새형(5 mm＜후도≤15 mm).②절단성병변(병변장도＞15 mm):분위절단협착화절단폐새.절단협착형우분위장절단협착형(＞30 mm)화단절단협착형(15mm＜협착장도≤30 mm)；절단폐새형진일보분위장절단폐새형(폐새장도＞20 mm)화단절단폐새형(15mm＜폐새장도≤20 mm).③외압성병변:주요위종대간미상협압박소치적하강정맥협착.각형균구상응초성표현.결론 경복화응용심장탐두경흉우심방하강정맥입구절면초성검사능대BCS환자하강정맥병변준학분형,유조우지도림상치료.
Objective To explore a compatible approach to detect and classify the lesions of inferior vena cavas (IVCs) on sonogram in patients with Budd-Chiari syndrome(BCS).Methods Ultrasonogram of the IVCs were observed detailedly in 300 patients with BCS by using trans-abdomen and trans-thorax-right atrium-inferior vena cava ingress sections.Transducers usually used for heart examination were applied in the latter.Lesions of the IVCs found in 277 out of 300 patients were classified.All lesions were confirmed by digital subtraction angiography (DSA) and among them,52 cases underwent computed tomography angiography (CTA).Results Lesions of IVCs were classified into 3 categories as follows:membranous type,segmental type,and ex-pressed type.① Membranous type (thickness ≤ 15 mm) included membranous stenosis type and membranous occlusion type.On the basis of the thickness,the membranous stenosis type was further classified into thinner membranous stenosis type (thickness ≤5mm) and thicker membranous stenosis type (5 mm＜thickness≤ 15 mm).The membranous occlusion type was further classified into thinner membranous occlusion type (thickness ≤5 mm) and thicker membranous occlusion type (5 mm＜thickness ≤15 mm).② Segmental type (lengtb ＞ 15 mm) was consist of segmental stenosis type and segmental occlusion type.Based on the length of the lesion,the segmental stenosis type was further divided into longer segmental stenosis type (length ＞ 30 mm) and shorter segmental stenosis type (15 mm＜length ≤30 mm).The segmental occlusion type was further divided into longer segmental occlusion type (length ＞ 20mm) and shorter segmental occlusion type (15 mm＜ length ≤20 mm).③ Ex-pressed type of IVCs was mainly caused by compression of intumescent caudate lobes.Corresponding sonographic features were demonstrated in each type.Conclusions Ultrasonogram of trans-abdomen and trans-thorax-right atrium-inferior vena cava ingress sections could accurately classify the lesions of IVCs.It is of important significance for the clinical treatment.