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目的:评价BCS行下腔静脉造影中见到的一种征象用于诊断肝静脉口部膜性阻塞及指导穿刺破膜。资料与方法:对17例拟珍BCS的病人做了下腔静脉造影,其中5例诊断肝静脉膜性阻塞者经颈静脉或股静脉,用下腔静脉造影所示“乳头征”或结合术中超声引导穿刺针破膜,行肝静脉测压、造影及球囊扩张。结果:5例肝静脉膜性阻塞下腔静脉造影都见到壁向腔内的结节状充盈缺损。经腔静脉穿刺破膜均获成功。肝静脉造影证实口部膜性阻塞。球囊扩张后重建了肝静脉流出道,肝静脉压平均下降1.84kPa。结论:下腔静脉造影显示的壁向腔内结节状突起提示肝静脉口部膜性阻塞。此征象可作为穿刺标记开通肝静脉。
OBJECTIVE: To evaluate a sign seen in inferior vena cava angiography (BCS) for the diagnosis of membranous obstruction in the hepatic veins and to guide the punctures. Materials and Methods: Inferior vena cava angiography was performed in 17 cases of pseudo BCS patients. Among them, 5 cases were diagnosed as hepatic vein occlusion via jugular vein or femoral vein. Ultrasound guided puncture needle rupture, hepatic venous pressure, angiography and balloon dilatation. Results: All the 5 cases of hepatic venous obstruction with inferior vena cava angiography showed nodular filling defect in the wall. The vena cava puncture rupture was successful. Hepatic venography confirmed oral membranous obstruction. Balloon dilatation and reconstruction of the hepatic vein outflow tract, hepatic venous pressure decreased by an average of 1.84kPa. CONCLUSIONS: Inferior vena cava angiography shows a wall-like nodular protrusion that suggests membranous obstruction in the hepatic veins. This sign can be used as a puncture mark open hepatic vein.