肝静脉血栓形成

摘要： 目的:评价布-加综合征(Budd-Chiari syndrome,BCS)介入治疗的远期疗效及影响生存情况的相关因素.方法:回顾性分析1988年7月—2013年8月我院164例行介入治疗的BCS患者的资料.根据血管造影结果对患者进行临床分型(徐克分型),对其中141例成功治疗并获得随访结果的病例资料进行临床分析.连续型变量以中位数和范围的形式表达,两组之间比较用独立样本t检验或非参数Mann-Whitney检验,分类型变量以绝对值和相对比例的形式表达,两组之间比较用卡方检验、Fisher精确检验.累积生存率用Kaplan-Meier法,两组之间比较用Log rank检验.对于生存情况的独立预后因素用Cox比例风险模型.结果:164例BCS患者中161例拟行介入开通治疗,其中153例获得成功(开通成功率为95％),8例患者开通治疗失败,原因为肝静脉弥漫性闭塞(6例)及下腔静脉长段闭塞(2例).3例因门静脉高压合并上消化道出血和难治性腹水进行改良TIPS治疗并均获得成功.153例开通成功的患者中,2例分别于术后16 h及72 h死于弥漫性血管内溶血(Disseminated in-travascular coagulation,DIC)和严重咯血,10例患者开通术后失访,余下的141例患者被纳入本研究中.各分型中,单纯球囊扩张患者和支架置入患者再狭窄率的差别没有统计学意义(P>0.1,卡方检验).单纯肝静脉病变患者再狭窄率高于下腔静脉膜性病变患者(P<0.01,卡方检验),而累积生存率低于后者(P<0.01,Log rank检验).对于行介入开通治疗的BCS患者,再狭窄的发生是预后不良的独立危险因素(P<0.001).而在发生再狭窄的患者中,接受再次介入治疗患者的累积生存率高于未接受再次介入治疗的患者(P<0.001).结论:对于行介入治疗的BCS患者,最初的治疗应首选单纯球囊扩张术,对于节段性闭塞或单纯球囊扩张效果不理想及发生再狭窄的患者可选择支架治疗.再狭窄的发生是影响临床疗效的主要因素,对于发生再狭窄的患者,应进行再次介入开通治疗.

摘要： 目的 评估CT对下腔静脉型Budd-Chiari综合征(BCS)介入治疗的临床指导价值.方法 收集于我院接受介入治疗的329例下腔静脉型BCS患者,所有患者术前均接受CT检查,并根据CT诊断结果制定介入治疗方案.以DSA治疗结果为金标准,评估CT诊断的准确率、敏感度、特异度、阳性预测值和阴性预测值.结果 DSA示下腔静脉不完全闭塞型BCS 108例,下腔静脉完全闭塞型221例;CT诊断下腔静脉不完全闭塞型99例,下腔静脉完全闭塞型230例.与DSA结果相比,CT诊断15例假阴性,6例假阳性.CT术前制定是否破膜的准确率、敏感度、特异度、阳性预测值及阴性预测值分别为94.19％、97.29％、86.11％、93.49％及93.94％,CT术前制定介入治疗方法的准确率、敏感度、特异度、阳性预测值及阴性预测值分别为97.55％、100％、92.52％、96.49％和100％.结论 CT诊断下腔静脉型BCS准确率较高,且有助于制定介入治疗方案.%Objective To explore the clinical value of CT for guiding interventional therapy of Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) obstruction.Methods A total of 329 consecutive BCS patients with IVC obstruction underwent endovascular treatment.All the patients underwent CT examination prior to endovascular treatment,and the data were retrospectively reviewed.The accuracy,sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) of CT were compared with results of DSA.Results DSA showed partial obstructive IVC in 108 BCS patients and complete obstructive IVC in 221 patients.CT demonstrated partially obstructive IVC in 99 patients and completely obstructive IVC in 230 patients.CT revealed 15 false-negative and 6 false-positive results.CT diagnosis of puncture or not yielded an accuracy of 94.19％,sensitivity of 97.29％,specificity of 86.11％,PPV of 93.49％ and NPV of 93.94 ％ for detection of BCS with partial IVC obstruction,while CT-based interventional treatment plan yield an accuracy of 97.55 ％,sensitivity of 100 ％,specificity of 92.52 ％,PPV of 96.49 ％ and NPVof 100％.Conclusion CT can provide high diagnostic accuracy and sensitivity for BCS patients with obstructed IVC,therefore being helpful to planning interventional treatment of BCS.

摘要： 目的：探讨Budd-Chiari综合征合并肝静脉血栓形成介入治疗的护理要点。方法回顾性分析Budd-Chiari综合征合并肝静脉血栓形成患者36例，均行肝静脉置管溶栓术，球囊扩张和（或）支架置入术，总结围术期的护理方法。结果36例患者均置管成功，导管平均保留时间5.5 d，其中1例发生心包填塞经及时治疗和精心护理后痊愈，除1例因发生腹腔出血拔除溶栓导管外，35例患者临床症状均得到明显改善。结论严密的病情观察和精心细致的专科护理对治疗成功具有重要价值。

摘要： 目的 研究肝静脉(HV)血栓型布-加综合征(BCS)患者的临床特征.方法 以2010年6月至2012年12月我院连续收治的16例HV血栓型BCS患者作为研究对象,并与同期连续收治的132例其他类型BCS患者进行对比研究.回顾性分析两组患者住院及随访资料.随访截止时间为2013年6月,中位随访时间为24个月(6 ～ 36个月).采用独立样本t检验及Wilcoxon W秩和检验分析定量资料组间差异性,采用x2检验或Fisher确切概率法分析定性资料组间差异性,采用Kaplan-Meier法计算患者生存率及复发率.结果 HV血栓型BCS患者年龄、症状持续时间、白蛋白水平、脾脏直径及生存率等指标均低于其他类型BCS患者;HV血栓型BCS患者腹水比例、平均住院时间、天冬氨酸转氨酶、丙氨酸转氨酶、糖类蛋白抗原-125、总胆红素、Rotterdam BCS预后分级及介入术后复发率等指标均高于其他类型BCS患者.以上各个指标组间差异性均有统计学意义(P＜0.05).结论 与其他类型的BCS相比,HV血栓型BCS是一类发病年龄轻,症状和肝脏损伤重,介入治疗难度较大,预后差的急性BCS.%Objective To study the clinical features and prognosis of patients with primary BuddChiari syndrome (BCS) caused by hepatic vein thrombosis.Method 16 patients with primary BCS caused by hepatic vein thrombosis treated in our hospital between June 2010 to December 2012 were used as the study group while 132 patients with primary BCS caused by other causes were used as the control group.A retrospective study was then employed to analyze the clinical data of the two groups of patients during hospitalization and on follow-up.The study was censored in June 2013.The median follow-up was 24 months (range,6 months to 36 months).The difference in quantitative data between the 2 groups were analyzed using the independent-samples t test and the Wilcoxon W rank sum test,and the difference in qualitative data were analyzed using the Chi-square test and the Fisher's exact test.The survival rates and recurrence rates were calculated using the Kaplan-Meier method.Result The study group was significantly lower than the control group in age,duration of symptoms,albumin level,diameter of spleen and survival rate,but it was significantly higher in the proportion of patients with ascites,average hospitalization time,alanine transaminase,aspartate aminotransferase,total bilirubin,carbohydrate antigen-125 and recurrence rate after percutaneous transluminal angioplasty.The differences were significant (P ＜ 0.05).The Rotterdam BCS prognosis grades of the study group were:9 patients grade Ⅱ and 7 patients grade Ⅲ.In the control group,there were 65 patients with grade Ⅰ,51 patients with grade Ⅱ,and 16 patients with grade Ⅲ.The prognosis grade of the study group was significantly higher than the control group (P ＜ 0.05).Conclusion When compared to the patients with BCS due to other causes,patients with BCS caused by hepatic vein thrombosis were more common in the young,most of them were diagnosed in the acute period,they had worse clinical outcomes and had more severe clinical symptoms and liver damage.

摘要： 目的：采用多排螺旋CT增强扫描及三维重建技术评价急慢性门静脉系统血栓（PVT）。方法回顾性分析已证实的住院患者PVT的增强螺旋CT表现。根据症状发作时间将PVT分为急性期、慢性期，根据形态将血栓分为Ⅰ型完全型和Ⅱ型偏心型，分别评价门静脉直径、血栓位置、形态、密度、强化及伴随征象。结果 PVT形成患者19例。急性期3例，均为完全型；2例同时累及门静脉主干、左右分支、肠系膜上静脉及脾静脉，1例累及除门静脉主干外的其他3支血管。血栓CT值平均为（39±19）Hu，2例在血栓内部或边缘可见轻度强化。均有肠壁增厚、肠腔扩张积液、肠系膜水肿、腹水及侧支循环形成。慢性期16例，3例累及4支血管，4例累及3支，7例累及2支，2例累及1支。5例为完全型，11例为偏心型（68．8％），其中8例（72．7％）血栓宽径小于门脉宽径的50％。血栓 CT值平均为（41±12）Hu，3例强化。腹水15例，肠系膜水肿10例，侧支循环形成14例。结论 MSCT增强扫描可对急慢性PVT的累及范围及形态特点做出准确评价。%Objective To evaluate acute or chronic portal vein system thrombosis(PVT)using multiple slice spiral computer tomography(MSCT).Enhancement MSCT and three-dimensional CT reconstruction technique were applied in all patients.Methods Findings from inpatients proved portal vein system thrombosis were retrospectively reviewed.The portal venous system thrombosis was divided into acute or chronic stages according to the time from the onset of symptoms.The form of the blood clots fell into Ⅰ complete type and Ⅱ eccentric type.The diameter of the portal vein(DPV)was measured,and the location,shape,density,enhancement of the thrombi and the accompanying signs were assessed.Results Nineteen inpatients with portal vein system thrombosis were enrolled.Three cases were acute PVT and all were type Ⅰ.There were two cases involving portal vein,at the same time around the trunk, branches,superior mesenteric vein and splenic vein.One case was involved the other three veins in addition to the main trunk of portal vein.The average CT value of the acute thrombi was (39±19)Hu.Two cases could be seen the light enhancement at the edge or within the thrombi.Bowel wall thickening,lumen effusion and expanding,mesenteric edema,ascites,and collateral circulation could be seen in all cases.Sixteen patients were chronic PVT.There were two cases involving four blood vessels aforementioned,four cases involving three blood vessels,seven cases involving two blood vessels,and two cases involving one blood vessel.Five cases were type Ⅰ and eleven cases were type Ⅱ.In the type Ⅱ,the width of the clots was less than 50% of DPV in eight cases.The average CT value was (41 ± 12)Hu. Three cases could be seen light enhancement of the blood clots.Ascites (n =15),mesenteric edema (n =10), collateral circulation (n=14)could be observed.Conclusion The scope and form characteristics of acute or chronic PVT could be evaluated accurately by enhancement MSCT.

摘要： 目的:探讨磁共振LAVA技术对Budd-Chiari综合征显示及其分型价值.方法:25例Budd-Chiari综合征患者行MRI检查,均采用肝脏加速容积采集序列(LAVA),分析图像质量及显示肝静脉、下腔静脉和侧支循环.结果:14例下腔静脉型,其中12例下腔静脉闭塞或狭窄,2例下腔静脉腔内阻塞性隔膜;肝静脉型7例,混合型4例.副肝静脉增粗18例,肝内侧支循环22例,肝外侧支血管形成21例.结论:磁共振LAVA技术能清楚显示下腔静脉、肝静脉的正常解剖和各种病变,对Budd-Chiari综合征病变的程度、部分、侧支血管分布及分型具有较高的诊断价值.

摘要： 目的:分析Budd-Chiari综合征(BCS)介入治疗并发症的防治.方法:回顾性分析524例介入治疗BCS患者的临床资料,其中介入治疗术中及术后共发生主要并发症74例(74/524,14.1％),探讨并发症的分类、发生原因及处理方法.结果:74例介入治疗并发症患者中,死亡3例(0.57％),余均成功救治.其中术中、术后出现的主要并发症有:穿刺局部严重并发症6例；早期诊断性造影后下腔静脉内血栓形成3例；出血6例；弥散性血管内凝血2例；误穿心包16例,导致心包填塞4例(1例死亡)；球囊扩张成形术(PTA)术中急性再狭窄5例,术后再狭窄17例；支架相关并发症19例,发生率l3.4％,占总体并发症25.7％(19/74).结论:介入治疗BCS创伤小、安全有效,但也存在较为严重的并发症,应采取各种措施减少和避免其发生,提高并发症的处理水平及临床成功率.%Objective: To discuss the prevention and treatment of complications in interventional therapy for Budd-Chiari syndrome (BCS). Methods: Clinical data of 524 patients with BCS treated via interventional therapy were retrospectively analyzed. Among the patients, 74 cases suffered from intraoperative and postoperative complications(74/524, 14.1%). Types of complications, together with their causes and treatment methods were studied. Results: Among the 74 patients who suffered from complications, death occurred in three and successful treatment was obtained in all the other cases, with a death rate of 0.57%. The intraoperative and postoperative complications included those occurring in the puncture sites (n=6), inferior vena cava thrombosis after early diagnostic angiography(n=3), bleeding(n=6), disseminated intravascular coagulation(n =2), mistakenly puncturing into pericardium(n= 16), pericardial tamponade(n=4, death in one), acute restenosis during the treatment via PTA(n= 5), postoperative restenosis(n=17), cases related to stents(n=19). The incidence rate related to stents was 13.4%, which accounted for 25.7% in all the cases (19/74). Conclusion: Interventional therapy is safe and effective for the treatment of BCS with the advantage of little trauma. However, many kinds of complications still might happen. All kinds of preventive measures should be taken to avoid or reduce the possible complications so as to improve the clinical success rate of interventional therapy.

摘要： 目的 探讨超声血管增强技术(VET)在布-加综合征(BCS)支架置入术后疗效评估中的应用价值.方法 对39例BCS置入支架患者共41个支架进行二维超声、彩色多普勒及VET检查,存储支架及所在血管的静态及动态图像,比较血管内支架的二维与VET图像质量.对超声检查发现的支架狭窄的患者行数字减影血管造影(DSA)检查,测量支架内血栓范围,并与VET检查结果进行比较.结果 VET技术显示血管内支架图像质量评分高于二维超声,二者比较差异有统计学意义.VET显示的支架内血栓范围与DSA结果相近.结论 VET可改善血管内支架的清晰度,与彩色多普勒相结合,提高了超声在BCS支架置入术后疗效评估中的应用价值.%Objective To explore the value of vascular enhancement technology (VET) in the evaluation of therapeutic efficacy of stenting for Budd-Chiari syndrome (BCS).Methods Two-dimensional ultrasound,color Doppler and VET were performed on 39 BCS patients with 41 stents,the static and dynamic images of stents and vessels with stents were stored.VET and two-dimensional ultrasound imaging quality of intravascular stent were compared.Patients with stent stenosis found by ultrasound were examined by digital subtraction angiography(DSA).The ranges of stent thrombosis were measured by DSA and VET and the difference was compared.Results VET image quality scores of endovascular stent were higher than those of the two-dimensional ultrasound,the difference was statistically significant.The ranges of stent thrombosis measured by VET were similar to DSA.Conclusions VET can improve the clarity of intravascular stents.VET and color Doppler can enhance the clinical value of ultrasound in the evaluation of therapeutic efficacy of stenting for BCS.

摘要： 治疗下肢静脉血栓形成和血栓性浅静脉炎的药物。目前，在治疗慢性下肢静脉血栓形成和血栓性浅静脉炎病多采用抗凝疗法，但对治疗静脉血栓形成疗效不理想，慢性期尚无有效疗法，国内采用中西医结合疗法，在改善临床症状、消肿止痛、加强侧枝建立方面有一定作用，将产品用于消栓，使闭塞的静脉再通的效果，尚缺少有力佐证。治疗下肢静脉血栓形成和血栓性浅静脉炎的药物，其组成包括：中药，所述的中药包括：丹参、王不留行、土茯苓、三七、大蓟、玄参和川牛膝，其重量份数为丹参3～5、王不留行3～7、土茯苓5～20、三七0.5～3、大蓟3～5、玄参1～5、川牛膝1.5～3。本产品用于治疗下肢静脉血栓形成和血栓性浅静脉炎病症。

摘要： 本发明属于药品技术领域，特别涉及一种治疗肢体静脉血栓形成、静脉炎的外敷药物。其特征在于是由取按重量百分比为黄豆粉80-85％、木瓜粉7-8％、没药粉2.5-4.5％、土茯苓粉3-5.5％、紫草粉2.5-3.5％组成松散粉剂，并按以下方法制成，取干黄豆、干木瓜、干没药、干土茯苓、干紫草分别粉碎研成细末，过80目筛而制成黄豆粉、木瓜粉、没药粉、土茯苓粉、紫草粉，按上述重量比混合均匀制成松散粉剂，混匀后灭菌处理10-20分钟制得松散粉剂。将松散粉剂按350±2克装入医用塑料袋内封口，使用时将350±2克的松散粉剂与500毫升的浓度为5-20％的硫酸镁溶液混合调至成糊状。本发明的优点是：生产工艺简单，药品组方科学合理，疗效确切、明显，治疗疗程短、对人体无疼痛、无毒副作用、价格低廉、治疗方便的中成药，值得推广。

摘要： 治疗下肢静脉血栓形成和血栓性浅静脉炎的药物及制备。目前，在治疗下肢静脉血栓形成和血栓性浅静脉炎病多采用抗凝疗法，但对治疗静脉血栓形成疗效不理想，国内采用中西医结合疗法，在改善临床症状、消肿止痛、加强侧枝建立方面有一定作用，将产品用于消栓，使闭塞的静脉再通的效果，尚缺少有力佐证。治疗下肢静脉血栓形成和血栓性浅静脉炎的药物，其组成包括中药，所述的中药包括：丹参、王不留行、土茯苓、三七、大蓟、玄参和川牛膝，其重量份数为丹参3～5、王不留行3～7、土茯苓5～20、三七0.5～3、大蓟3～5、玄参1～5、川牛膝1.5～3。本产品用于治疗下肢静脉血栓形成和血栓性浅静脉炎病症。

摘要： 本发明属于药品技术领域，特别涉及一种治疗肢体静脉血栓形成、静脉炎的外敷药物。其特征在于是由取按重量百分比为黄豆粉80－85％、木瓜粉7－8％、没药粉2.5－4.5％、土茯苓粉3－5.5％、紫草粉2.5－3.5％组成松散粉剂，并按以下方法制成，取干黄豆、干木瓜、干没药、干土茯苓、干紫草分别粉碎研成细末，过80目筛而制成黄豆粉、木瓜粉、没药粉、土茯苓粉、紫草粉，按上述重量比混合均匀制成松散粉剂，混匀后灭菌处理10－20分钟制得松散粉剂。将松散粉剂按350±2克装入医用塑料袋内封口，使用时将350±2克的松散粉剂与500毫升的浓度为5－20％的硫酸镁溶液混合调至成糊状。本发明的优点是：生产工艺简单，药品组方科学合理，疗效确切、明显，治疗疗程短、对人体无疼痛、无毒副作用、价格低廉、治疗方便的中成药，值得推广。

摘要： 本发明公开了预防四肢静脉血栓形成的康复装置，属于医疗器械技术领域，其技术方案要点包括固定板，所述固定板的顶部固定连接有放置架，所述放置架的内腔设置有充气按压机构，所述固定板的右侧设置有固定架，所述固定架的内腔设置有活动板，所述活动板前侧的顶部设置有与固定架配合使用的定位机构，所述固定架的前侧开设有与定位机构配合使用的定位槽，所述活动板顶部的左侧固定连接有活动轴，所述活动轴的顶部固定连接有放置板，所述放置板前侧的顶部固定连接有正魔术贴，使康复装置可以对患者的四肢进行康复使用，同时在治疗过程中，可以对患者进行多方位同时治疗的作用，提高患者治疗效果的问题。

摘要： 本发明公开了预防四肢静脉血栓形成的康复装置，属于医疗器械技术领域，其技术方案要点包括固定板，所述固定板的顶部固定连接有放置架，所述放置架的内腔设置有充气按压机构，所述固定板的右侧设置有固定架，所述固定架的内腔设置有活动板，所述活动板前侧的顶部设置有与固定架配合使用的定位机构，所述固定架的前侧开设有与定位机构配合使用的定位槽，所述活动板顶部的左侧固定连接有活动轴，所述活动轴的顶部固定连接有放置板，所述放置板前侧的顶部固定连接有正魔术贴，使康复装置可以对患者的四肢进行康复使用，同时在治疗过程中，可以对患者进行多方位同时治疗的作用，提高患者治疗效果的问题。

摘要： 本发明公开了一种预防PICC相关性静脉血栓形成的辅助锻炼工具，具体涉及医疗器具技术领域，包括握框，所述握框的一侧设有支撑挡板，所述握框、支撑挡板的顶端和底端均固定安装有绑带，所述握框中设有伸缩组件，本发明，通过设置握框、伸缩组件并配合使用伸缩组件，开启气囊输气泵机，伸缩气囊中气体通过多个通槽均匀进入疏气筒，并经过导气管进入气囊输气泵机中，此时，伸缩气囊均匀收缩，同步带动第一拉绳和第二拉绳移动，且第一拉绳和第二拉绳远离伸缩气囊的一端同步向握框的一侧移动，对应固指组件拉动患者手指同步向握框的一侧移动，手指握住握框，四指进入第一指槽中，且拇指进入第二指槽中，进而实现患者的自动辅助握拳。

摘要： 本实用新型公开了一种预防下肢静脉血栓形成的训练器，包括上座板、支撑壳体以及下座板，上座板可拆卸连接于支撑壳体的上端部，其上表面上对称设置有两个弹性踏板，下座板可拆卸连接于支撑壳体的下端部，其上表面上对称设置有两个电动踏板。本预防下肢静脉血栓形成的训练器，可以在熏蒸理疗过程中，对人体脚部进行按摩及脚腕锻炼，可适用于不同身高的人，实用性强，效果好。本预防下肢静脉血栓形成的训练器，可一机两用，通过在上座板上设置弹性踏板，可以让脚部能够移动的患者能做自主训练，通过在下座板上设置电动踏板，可以让脚部不能自主移动的患者，跟随电动踏板做被动训练。

摘要： 本实用新型公开了一种预防下肢深静脉血栓形成装置，包括三个绑带部，所述绑带部包括充气绑带与碳纤维加热垫，所述充气绑带的一侧面固定有母魔术贴，所述碳纤维加热垫的一侧面固定有子魔术贴，且子魔术贴与母魔术贴为相匹配设置，所述碳纤维加热垫上固定有线缆，所述绑带部的外侧设置有隔离机构，所述隔离机构被装配为用于防止碳纤维加热垫与用户皮肤的直接接触，所述充气绑带的进气口连通有导气管，且导气管的一端设置有气筒。该预防下肢深静脉血栓形成装置通过设置碳纤维加热垫来对用户的下肢进行加热，从而可以扩张用户下肢的血管，加快血液的循环流通，预防血栓的效果更佳，且结构简单，使用成本低，实用性强。

摘要： 本实用新型属于医疗器械技术领域，且公开了一种预防下肢深静脉血栓形成的活动设备，包括底板，所述底板顶部的右端固定安装有靠板，所述底板顶部右端的两侧均开设有固定孔，所述底板顶部右端的中部两侧设置有导轨，所述导轨的上方活动卡接有支撑板，所述支撑板两端的底部均固定安装有导筒。本实用新型通过二号电机转动可控制绑定带进行前后翻转，具体对病患的脚裸处进行辅助拉伸和回缩运动，一号电机启动，一号电机带动传动带运动，传动带带动转动杆和支架转动，由此可以对病人的脚踝处同时进行辅助顺逆时针转动运动，病人可以借助该设备在无护理人员指导的情况下进行自我活动，无须工作人员在一旁陪同使用，大大提高了病人的自由度。