目的 总结布-加综合征患者发生血小板减少症的危险因素.方法 120例布-加综合征患者,根据是否发生血小板减少症分为血小板减少症组48例、无血小板减少组72例.收集两组患者的性别、年龄、病程、解剖分型等一般资料,白蛋白、胆红素、肌酐、凝血酶原时间(PT)、国际标准化比值(INR)、血红蛋白含量等血细胞学指标.采用Logistic回归分析法分析布-加综合征患者发生血小板减少症的危险因素.结果 血小板减少症组年龄、病程、解剖分型、胆红素水平等与无血小板减少组相比,P均<0.05.年龄、病程、胆红素水平是布-加综合征患者发生血小板减少症的影响因素.结论 布-加综合征患者可能发生血小板减少症,年龄大、病程长、高胆红素水平是布-加综合征患者发生血小板减少症的危险因素.

目的 探讨布-加综合征(BCS)人工血管转术后流吻合口狭窄再处理情况.方法 收集2016—2020年火箭军特色医学中心收治的9例BCS患者的临床资料,根据治疗方法的不同将其分为介入组(n=6)和手术组(n=3).介入组中5例行单纯经皮血管腔内成型术(PTA),1例溶栓后行PTA球囊扩张肠系膜吻合口.手术组开腹行肠系膜吻合口增生内膜剥脱血管重建.观察比较两组患者的术后腹围、血浆白蛋白、门静脉压力变化情况.结果 两组患者门静脉压力、腹围、白蛋白比较,差异均无统计学意义(P>0.05).术后随访,介入组患者肝功能好转4例,手术组患者肝功能好转2例.结论 BCS人工血管转流远期吻合口狭窄较为常见,在充分评估吻合口及分流道情况下选择合适的治疗方式,介入球囊扩张和开放手术吻合口重建远期效果无明显差异.

目的 探讨大隐静脉主干剥脱联合红外线引导下侧支泡沫硬化剂注射治疗大隐静脉曲张的临床疗效.方法 收集2021年3月至2021年9月于火箭军特色医学中心行大隐静脉主干剥脱联合红外线引导下侧支泡沫硬化剂注射的30例大隐静脉曲张患者为观察组,收集2021年3月之前于火箭军特色医学中心行常规大隐静脉主干剥脱侧支泡沫硬化剂注射的30例大隐静脉曲张患者为对照组.比较两组患者手术时间、泡沫硬化剂用量、并发症(血栓性静脉炎、皮肤色素沉着)发生率、二次干预率.结果 观察组患者泡沫硬化剂用量少于对照组患者,差异有统计学意义(P<0.05).观察组患者并发症总发生率为10.0％(3/30),低于对照组的20.0％(6/30),二次干预率低于对照组患者,但差异均无统计学意义(P>0.05).术后,两组患者均未出现干咳、胸闷及下肢深静脉血栓等不良反应.结论 大隐静脉主干剥脱联合红外线引导下侧支泡沫硬化剂注射治疗大隐静脉曲张疗效满意,操作方便,值得进一步推广.

随着中心静脉置管和介入手术的广泛应用,医源性血管内异物的发生率随之升高.自20世纪80年代起,国内已经开始对医源性血管内异物进行治疗[1-2].常见的医源性血管内异物包括各种导管、导丝、完全植入式静脉输液港、经外周静脉穿刺的中心静脉导管(peripherally inserted central venous catheter,PICC )、下腔静脉滤器及各种封堵装置.对于医源性血管内异物的处理,通常首选介入手术取出,可以采取局部血管切开或腹腔镜辅助;在上述方法不能解决的情况下也可以采用开放手术进行治疗[1-4].本文对4例医源性血管内异物取出患者的病历资料进行分析,并结合相关文献对医源性血管内异物患者的临床特征、诊治过程进行探讨,以期能够为医源性血管内异物的临床诊治提供可供参考的处理策略,现报道如下.

病例资料患者,男,50岁,因“确诊布加综合征10年,腹壁静脉曲张进行性加重,间断腹胀、下肢酸胀半年,消化道出血6d”入院.患者于10年前明确“布加综合征”诊断,先后行“下腔静脉球囊扩张术”7次.每次治疗后下肢肿胀及酸胀感均减轻,但持续半年至1年不等后,肿胀再次出现.本次主要因下肢酸胀明显,活动后肿胀加重入院.

Objective To investigate the clinical efficacy of superior mesenteric artery(SMA) catheter thrombolysis in the early treatment of acute superior mesenteric venous thrombosis (ASMVT).Methods Six cases of ASMVT treated with SMA catheter thrombolysis were reviewed.The diagnosis,treatment and prognosis of the patients were analyzed.Results In 6 patients,except for 1 cases undergoing laparotomy for intestinal resection,the remaining treatments were successful with no obvious complications.The blood circulation rate of the mesenteric vein in the interventional treatment reached 60.0％,and the abdominal symptoms disappeared.The patients were followed up for half a year to 2 years,and 1 cases relapsed.Conclusion Interventional therapy has the advantages of less trauma,simple operation and less complications.For patients without necrosis of the ASMVT,early intervention with adequate anticoagulation may improve patient outcomes considerably.

Budd-Chiari syndrome (BCS) is a rare hepatic disease caused by occlusion of the hepatic venous outflow at any level from the small hepatic veins to the atriocava junction. BCS could have serious consequences if not treated promptly. The appropriate therapeutic strategy can be offered to change the natural course of the disease. The present case reports a young man with BCS who successfully received the hybrid treatment combined with endovascular intervention and mesocaval shunt by step. The 11-year follow-up showed that the patient was free of clinical symptoms, and computed tomography and ultrasonography confirmed the patency of the stent and shunt. Although BCS therapy methods are well established, the patient often needs to be treated repeatedly because of the high risk of recurrence. Step therapeutic strategy to alleviate portal and inferior vena cava hypertension of BCS patients are respected. The combination of endovascular intervention and mesocaval shunt was effective in our patient, and both stent and shunt have satisfactory long-term patency.

Background: The long-term efficacy of mesoatrial shunt (MAS) for Budd-Chiari syndrome (BCS) is not well studied. The purpose of our study was to investigate the long-term outcome and efficacy of MAS for BCS. Methods: We retrospectively evaluated 11 patients who underwent MAS for BCS from April 1986 to November 1995. Records of patients' clinical presentations, laboratorial investigation, Doppler duplex ultrasonography, radiologic image, and treatment outcomes were all retrieved and analyzed. Results: Follow-up intervals ranged from 1 year and 2 months to 30 years and 2 months (mean, 17 years and 8 months). Portal pressure decreased significantly from 35.72 +/- 3.52 cm H2O to 27.86 +/- 5.83 cm H2O post-MAS (P = 0.001). The 5-year, 10-year, and 20-year patency were 72.7%, 54.5%, 36.4%, respectively; 63.3% of patients had survived for more than 10 years and 45.5% for more than 20 years. A male has been alive with patent shunt for 28 years and 1 month. Conclusions: The MAS with enforced rings is an effective therapeutic modality for BCS with cautious perioperative management.

目的 探讨导管直接溶栓(catheter directed thrombolysis,CDT)对下肢急性深静脉血栓形成(acutedeep venous thrombosis,ADVT)的治疗效果.方法 回顾性分析笔者所在医院2014年1月至2015年10月期间收治的46例下肢ADVT患者治疗前后的患侧膝上15 cm周径、患侧膝下15 cm周径及通畅改善度评分,分析CDT对下肢ADVT的治疗效果.结果 所有患者均成功置管,其中5例经健侧“翻山”逆行置管,40例在超声引导下经患侧腘静脉顺行置管,1例经患侧股静脉置管.46例患者均成功置管溶栓,溶栓时间3～12d、(4.7±1.8)d.治疗过程中8例出现不同情况并发症,经对症处理、停药及拔管后均缓解,无死亡.同组内与治疗前比较,全人群、22～45岁组及46～74岁组治疗后患侧的膝上15 cm周径(P=0.028,P=0.017,P=0.031)、膝下15 cm周径(P=0.035,P=0.038,P=0.047)及患侧通畅度评分均较低(P=0.023,P=0.028,P=0.031);同组内与健侧比较,全人群、22～45岁组及46～74岁组治疗后患侧膝上15 cm周径(P=0.073,P=0.387,P=0.358)和膝下15 cm周径(P=0.416,P=0.625,P=0.253)的差异均无统计学意义.治疗后经超声检查提示血管完全再通15例(32.6％),部分再通28例(60.9％),管腔未通3例(6.5％),总有效率为93.5％ (43/46).出院后有43例患者获访,随访时间1～ 24个月,中位数为18个月.随访期间,活动后患肢肿胀、皮肤颜色明显加深5例,患肢酸胀明显19例,部分再通者中深静脉血栓形成(DVT)复发9例,发生血栓形成后综合征(PTS) 11例.结论 CDT是治疗下肢ADVT最为直接和有效的方法.

目的:探讨肠系膜上动脉综合征（SMAS）所致胃食管反流（GER）性咳喘的诊治方法。方法:回顾性分析6例SMAS致GER性咳喘患者的临床资料。结果:患者的临床表现主要为上腹间断性胀痛、反酸、烧心、咳嗽、哮喘等,上消化道造影示十二指肠水平段受压。2例行保守治疗,4例行手术治疗。随访1.5~84个月,3例术后症状改善明显,1例术后并发胃瘫,予胃动力药物治疗后缓解;2例保守治疗,症状得到有效控制,但需长期服质子泵抑制剂及胃动力药物。结论:SMAS致GER性咳喘的诊治需兼顾SMAS和GER,手术与保守治疗相结合可获满意疗效。

双腔静脉阻塞(bicaval obstruction,BO)是上腔静脉综合征(superior vena cava syndrome,SVCS)合并下腔静脉综合征(inferior vena cava syndrome,IVCS)引起的疾病,临床罕见,治疗困难.笔者采用人工血管转流术治疗1例双腔静脉阻塞病人,随访28年,效果良好.报告如下.

目的 探讨布-加综合征(budd-chiari syndrome,BCS)的临床特点,分析误诊原因,以提高诊断水平.方法 对1例误诊为大隐静脉曲张的BCS的临床资料进行回顾性分析.结果 本例因双下肢及右侧胸腹壁静脉迂曲扩张18年入院,期间辗转就诊多家医院均按大隐静脉曲张予相关治疗无缓解,且逐渐加重,后就诊北京某医院,经详细查体结合腹部MRI检查、下腔静脉造影诊断为BCS,转入我院经电子胃镜、计算机断层X线血管造影检查诊断为BCS、门静脉高压、肝功能不全(Child A级).完善检查后,在体外循环辅助下,行BCS根治术,术后患者恢复顺利.结论 临床上单纯以下肢及腹壁静脉曲张为症状的BCS病例较少见,接诊此类患者时应详细询问病史、细致查体并及时行相关检查,以减少误诊误治.

异位曲张静脉(ectopic varices,EV)是指门静脉高压于食管胃底以外发生的曲张静脉,可单独存在或伴有其他部位的曲张静脉.EV可发生于除食管胃底以外的消化道任意部位,不同部位的异位出血包括十二指肠、空肠、肝区、结肠、直肠、肛缘、胆道系统、造瘘口、腹膜、脐周、肝镰状韧带、肝脏裸区、脾脏韧带、膀胱、横膈、卵巢和睾丸[1],膀胱、阴道、腹壁、腹膜、肝胃韧带、脾周等的发生率很低[2].EV破裂导致的出血占门静脉高压性出血的5％左右,但死亡率可达到40％[3].EV较少见,多为个案报道,目前临床对其治疗经验非常有限,故了解这些EV及出血的病例对消化道出血的诊断和治疗有积极的临床意义。

英国内科医师Budd[1](1845年)和奥地利病理医师Chiari[2](1899年)分别论述了由肝静脉和肝小静脉阻塞引起的肝后性门静脉高压症,称为布加综合征(Budd-Chiari syndrome,BCS).笔者在仔细分析了1911年Pleasants[3]报道的18例及其文献复习的314例下腔静脉阻塞病变后,发现分别有6例(33.3％)和62例(19.7％)伴有下腔静脉和肝静脉水平的病变,此种病变多见于东亚(如中国)和南非,故笔者认为,称之为肝静脉-腔静脉阻塞综合征或亚非型BCS更为合适.

Objective To study the characteristics and clinical value of contrast-enhanced ultrasound (CEUS) of Budd-Chiari syndrome(BCS).Methods The examination data of two-dimensional ultrasound and color Doppler ultrasound and CEUS of 32 patients with BCS retrospectively were analysed,the inferior vena cava,hepatic vein blood flow imaging characteristics were observed,all patients were confirmed by angiography and interventional treatment or surgery.Results The characteristic of CEUS of BCS:inferior vena cava and/or hepatic vein stenosis in local blood flow pattern turn narrowed,blocking local without enhancement.Post-hepatic inferior vena cava imaging was delayeds or not development,when the stenosis or obstruction was improved or removed after treatment,the post-hepatic inferior vena cava development time was significantly shortened.Development time had no obvious difference between narrow one and normal one among three main hepatic vein.Blood flow edge inner vessel can be well displayed,which is beneficial to show lunmen shape of narrow section and blood flow beam direction.The blood flow information inner vascular stent can be displayed.There was no angle dependence,can improve signal detection rate of low flow and low velocity blood flow.Conclusions CEUS can well display inferior vena cava,hepatic vein stenosis or obstruction with position,extent and degree,especially in identification of inferior vena cava or hepatic vein occlusion with severe stenosis,which has important value to the choice of operation method,the judgment of therapeutic effect and postoperative follow-up.

Objective To explore main points of ultrasonic differential diagnosis of Budd-Chiari syndrome(BCS) and similar diseases in order to reduce the misdiagnosis rate.Methods Clinical and iconography data of 12 patients misdiagnosed as having Budd-Chiari syndrome by color Doppler ultrasound were retrospectively analyzed.Results Main clinical manifestations of this group were seroperitoneum,hepatosplenomegaly,esophageal or abdominal varicose veins.Patients were misdiagnosed as having BCS by ultrasound in our hospital or other hospitals,and BCS was excluded by the inferior vena cavography.There were 6 patients with liver cirrhosis,2 patients with Abernethy malformation,2 patients with cavernous transformation of portal vein,1 patient with omental cysts,and 1 patient with abdominal cystic lymphangioma.The 6 patients with cirrhosis underwent conservative treatment,and others underwent corresponding surgical treatment.All patients' conditions improved and were discharged.Conclusion Ultrasonogram of Budd-Chiari syndrome may be easily confused with causes of inferior vena cava compression narrow,hepatic vein lesion and portal hypertension disease.Clinicians should combine it with the patient's posture,respiratory change,and change of the inferior vena cava in diagnosing so as to reduce the misdiagnosis rate.

患者女,55岁.因间断呕血黑便8年,再发呕血15 d于2011年1月8日入我院消化科.患者入院前15 d劳累后突发恶心伴呕鲜血,量约2500 ml,出现意识不清,于当地医院抢救治疗好转后出院.患者近8年间断呕血2次,量大,均为1500～2000 ml,当地医科大学附属医院诊断为"乙型肝炎后肝硬化、门脉高压症、食道胃底静脉曲张、脾大脾功能亢进".患者第2次呕血后于该院行食道胃底静脉断流+脾脏切除术.入院查体:胸腹壁未见明显曲张静脉,左侧肋弓下缘有疤痕约30 cm长.肝脏下缘未触及.听诊肠鸣音4～5次/min,大小便正常.入院化验示:Hb 79 g/L、PT 17.3 s、D-二聚体3.714 mg/L、纤维蛋白降解产物32.3 mg/L;肝肾功能正常.患者入院第2天晨起正常排便后上腹部剧烈持续性疼痛,与体位无关,无呕吐、发热、腹泻等症.听诊肠鸣音约3～4次/ min.

<正>患者1男性,31岁。因间断呕血、黑便2个月于2008年7月25日入院。查体:腹部膨隆,胸腹部浅静脉迂曲扩张,血流方向向上,腹围88cm,移动性浊音阳性。腹部CT静脉成像(computed

Objective To study the color Doppler ultrasound image characteristics and ultrasonic diagnosis classification of Budd-Chiari syndrome (BCS),so as to facilitate the treatment choice.Methods The clinical material of 126 BCS patients were retrospectively analyzed.All patients were proved by angiography,intervention or surgical treatment,and were classified according to the main color Doppler ultrasound images.Results According to the image characteristics of color Doppler ultrasound,BCS patients were divided into eight types:type Ⅰ,incomplete membrane of inferior vena cava in 30 cases; type Ⅱ,complete membrane of inferior vena cava in 3 cases;type Ⅲ,stenosis of inferior vena cava in 8 patients;type Ⅳ,inferior vena cava obstruction in 3 patients;type Ⅴ,stenosis of big hepatic vein in 20 cases;type Ⅵ,big hepatic vein obstruction in 15 cases; type Ⅶ,extensive obstruction of small hepatic vein in 9 cases; type Ⅷ,38 cases of mixed lesions.Conclusions Color Doppler ultrasound can display the stenosis or obstruction of the inferior vena cava,hepatic vein with property,position,degree and the hemodynamic changes,which are accurate and reliable to the diagnosis and classification of BCS.

患者男,39岁.因腹胀伴腹围增大11年,加重2个月,于2010年8月19日入院.1999年7月曾至某三甲综合医院诊断为"下腔静脉膜性梗阻,肝脾大,腹水"建议行"介入治疗",患者因经济原因未行治疗.此后患者腹胀,腹围增大及双下肢水肿,色素沉着症状逐渐加重,出现皮肤巩膜黄染.至2010年7月初,患者自觉1个月内腹围迅速增大且双下肢水肿明显加重,食欲不佳,伴活动后气短,喘憋等症状,无呕血、黑便、腹痛、恶心、呕吐的症状发生,大小便正常.