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目的探讨彩色多普勒超声在诊断肝外型门静脉高压症中的临床诊断和肝血管指数的价值分析。方法选择86例肝外型门静脉高压症患者作为观察组,另外选择20例正常人作为对照组,采用HDI 5000彩色多普勒超声仪,频率设置为2.0~5.0 MHz,测定肝外型门静脉高压症的门脉系统的声像特征和血液动力学。结果 86例肝外型门静脉高压症患者均行血管造影证实,彩超定位诊断符合率100%(86/86),其中49例门静脉海绵变形,彩超显示网络状、蜂窝状或多条相互交错迂曲管状的异常五彩花色血流,在门脉区域蜂窝状或管状暗区内出现连续、低速、单向门静脉的血流,呈现正向或负向,峰值12.3~40.1 cm/s,平均为17.9 cm/s。29例布-查氏综合症,表现为肝脏下腔静脉或肝静脉出现闭塞或狭窄,肝脏体积变大,包膜光滑、形态规则,肝血流速度减慢,肝脏实质回声呈弥漫性增强,肝脏静脉出现变宽、交通支,门脉变宽。11例淤血性肝硬化,肝脏实质回声增粗增强,肝静脉及下腔静脉变宽,肝内血流丰富,但肝血流速度明显减慢。5例门静脉狭窄,表现为肝实质回声较为均匀,左叶肝脏体积变小,肝静脉内径未出现异常,门静脉左支出现异常狭窄,表现为五彩花色血流。2例区域性的门静脉高压在胰尾脾门处出现静脉迂曲,表现为五彩花色血流。与正常对照组相比,86例肝外型门静脉高压症患者的门静脉流速(PVV)、肝动脉搏动指数(HA-PI)、肝血管指数(LVI)显著改变,差异具有统计学意义(P<0.05)。结论肝外型门静脉高压症患者的彩色多普勒超声具有一定的特征,可能与临床预后及病因诊断、临床治疗方式密切相关,彩色多普勒超声能充分显示血管的形态、走向及相应的血液动力学指标,明确发生病变的部位,对肝外型门静脉高压症的早期诊断和治疗有重要的临床价值。
Objective To explore the value of color Doppler ultrasound in the diagnosis of extrahepatic portal hypertension in clinical diagnosis and hepatic vascular index value analysis. Methods Eighty-six patients with extrahepatic portal hypertension were selected as the observation group and another 20 normal subjects were selected as the control group. HDI 5000 color Doppler was used and the frequency was set at 2.0-5.0 MHz. The incidence of extrahepatic portal hypertension The portal system features sonographic features and hemodynamics. Results 86 cases of extrahepatic portal hypertension were confirmed by angiography. The coincidence rate of color Doppler ultrasound diagnosis was 100% (86/86). Among them, 49 cases of portal vein sponge were deformed. Color ultrasonography showed network, honeycomb, Of the abnormal colorful flow of blood flow in the portal area honeycomb or tubular dark area appeared continuous, low velocity, unilateral portal vein blood flow, showing positive or negative peak value of 12.3 ~ 40.1 cm / s with an average of 17.9 cm / s. 29 cases of cloth-chashei syndrome, the performance of the hepatic inferior vena cava or hepatic vein occlusion or stenosis, the liver becomes larger, the envelope is smooth, regular pattern, the hepatic blood flow slows down, the liver echo was diffusely enhanced, Widening of the hepatic veins, traffic branch, widening portal. Eleven cases of congestive cirrhosis, thickening of the liver echo enhancement, widening of the hepatic vein and inferior vena cava, hepatic blood flow is rich, but the hepatic blood flow was significantly slowed down. 5 cases of portal vein stenosis, the performance of the liver parenchyma echo is uniform, the left lobe of the liver becomes smaller, the diameter of the hepatic vein does not appear abnormal, the left portal vein appears abnormal stenosis, manifested as colorful flow of color. 2 cases of regional portal hypertension in venous tail of the pancreas appears tortuous, manifested as colorful flow of color. Compared with the normal control group, the PVV, HA-PI and LVI of 86 patients with extrahepatic portal hypertension were significantly changed, the difference was statistically significant (P < 0.05). Conclusions Color Doppler echocardiography in patients with extrahepatic portal hypertension has some characteristics, which may be related to clinical prognosis, etiological diagnosis and clinical treatment. Color Doppler ultrasound can fully display the morphology and direction of blood vessels and the corresponding blood Kinetic indicators, a clear location of the lesion, the early diagnosis and treatment of extrahepatic portal hypertension have important clinical value.