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目的探讨应用血管造影技术鉴别诊断误诊为巴德-吉亚利综合征的缩窄型心包炎患者。方法回顾性分析378例以“巴德-吉亚利综合征”为早期诊断的病例,对所有病例均进行常规血管造影检查和术中测压。结果在所有病例中有5例患者血管造影检查显示下腔静脉和肝静脉管腔通畅,但压力明显高于正常,右心房压力也明显高于正常,定期随访1~24个月,这5例患者均发现不同程度心包钙化,最终进行心包部分或全部剥离术。病理结果:结核性心包炎4例,化脓性心包炎1例,支持缩窄型心包炎诊断。结论缩窄性心包炎部分临床病例症状不典型易误诊,建议有条件单位可应用血管造影技术进行下腔静脉、肝静脉、心脏各房室造影和测压明确有无上述血管疾患。
Objective To investigate the differential diagnosis of Budd-Chiari syndrome by angiography in patients with constrictive pericarditis. Methods A retrospective analysis of 378 cases with “Bad - Kialli syndrome” for the early diagnosis of cases, all cases were routine angiography and intraoperative manometry. Results In all cases, angiographic examination of 5 patients showed that the lumen of the inferior vena cava and the hepatic vein were unobstructed, but the pressure was significantly higher than normal and the right atrial pressure was also significantly higher than normal. The patients were followed up for 1 to 24 months regularly. Patients were found to varying degrees of pericardial calcification, the final pericardial partial or complete dissection. Pathological findings: 4 cases of tuberculous pericarditis, suppurative pericarditis in 1 case, supporting the diagnosis of constrictive pericarditis. Conclusion Some patients with constrictive pericarditis are often misdiagnosed as atypical asymptomatic symptoms. It is suggested that angiography can be used to determine the presence or absence of the above vascular diseases in the inferior vena cava, hepatic vein and cardiac chambers.