Ohta M, Hashizume M, Tomikawa M, Ueno K, Tanoue K, Sugimachi K
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Am J Gastroenterol. 1994 Feb;89(2):170-5.
We classified the Doppler waveform seen in patients with portal hypertension and examined the associations of the waveform type with the diagnosis of Budd-Chiari syndrome and severity of the liver cirrhosis.
The Doppler pattern of right and left hepatic veins in 100 consecutive Japanese patients with portal hypertension and esophagogastric varices was classified into six types: I, triphasic waveform; II, biphasic waveform without reversed flow; III, decreased amplitude of phasic oscillations; IV, flat waveform with fluttering; V, completely flat waveform with fluttering; VI, no waveform. All patients underwent computed tomography and magnetic resonance imaging. Patients in whom hepatic vein waveform showed type IV, type V, or type VI, positively underwent hepatic venography and inferior vena cavography.
Type I was seen in 31 of 100 patients, type II in 35, type III in 17, type IV in eight, type V in four, and type VI in five. Types I-IV waveform indicated no lesion in hepatic veins and inferior vena cava, type V indicated stenosis of hepatic veins or occlusion of inferior vena cava, and type VI, occlusion of hepatic veins. For one patient with type V hepatic veins, balloon angioplasty was done, and the waveform changed from type V to type II. Examining the relationship between hepatic vein waveform and the Child-Pugh score, liver function of type IV cases was worse than that of type I cases in 66 cirrhotic patients without hepatocellular carcinoma (p < 0.05). There was no clear relationship between hepatic vein waveform and portal venous perfusion, as based on Nordlinger's grade.
Our classification of hepatic vein waveform in Doppler ultrasonography is useful in diagnosing Budd-Chiari syndrome, in judging the efficiency of treatment for hepatic vein lesions, and in assessing severe liver function in cirrhotic patients.
我们对门静脉高压患者的多普勒波形进行分类，并研究波形类型与布加综合征诊断及肝硬化严重程度之间的关联。
对100例连续的日本门静脉高压合并食管胃静脉曲张患者的左右肝静脉多普勒模式分为六种类型：I型，三相波形；II型，无反向血流的双相波形；III型，相位振荡幅度降低；IV型，伴有扑动的平坦波形；V型，伴有扑动的完全平坦波形；VI型，无波形。所有患者均接受计算机断层扫描和磁共振成像检查。肝静脉波形显示为IV型、V型或VI型的患者积极接受肝静脉造影和下腔静脉造影。
100例患者中，I型31例，II型35例，III型17例，IV型8例，V型4例，VI型5例。I - IV型波形表明肝静脉和下腔静脉无病变，V型表明肝静脉狭窄或下腔静脉闭塞，VI型表明肝静脉闭塞。对于1例V型肝静脉患者，进行了球囊血管成形术，波形从V型变为II型。在66例无肝细胞癌的肝硬化患者中，检查肝静脉波形与Child - Pugh评分之间的关系，IV型病例的肝功能比I型病例差（p < 0.05）。基于诺德林格分级，肝静脉波形与门静脉灌注之间没有明确关系。
我们对多普勒超声检查中肝静脉波形的分类有助于诊断布加综合征，判断肝静脉病变的治疗效果，并评估肝硬化患者的严重肝功能。
