多层螺旋CT门静脉成像在食管胃静脉曲张栓塞术前评估中的价值  

Multi-slice Spiral CT Portography in Evaluating the Embolization of Gastroesophageal Varices Preoperatively

作　　者：王家臣[1] 巩若箴[2] 田军[2] 张春清[3] 丁霞[1] 孙建[1] 

机构地区：[1]山东大学医学院山东省医学影像学研究所,山东济南250021 [2]山东省医学影像学研究所 [3]山东省立医院消化科

出　　处：《实用放射学杂志》2008年第4期483-486,共4页Journal of Practical Radiology

基　　金：山东省科技计划项目(编号:2005GG4202024)

摘　　要：目的探讨多层螺旋CT门静脉成像(MSCTP)在食管胃静脉曲张栓塞术前评估中的价值。方法对50例门静脉高压上消化道出血患者行64层螺旋CT增强扫描,每例病人均采用多平面重组(MPR)、最大密度投影(MIP)和容积显示(VR)3种后处理方法显示门静脉系统血管。对42例明确显示食管胃静脉曲张相关侧枝血管的患者进行了介入栓塞治疗,5例门静脉海绵样变难以分清相关侧枝血管及3例门静脉部分血栓形成不能行介入栓塞治疗的患者做了内镜套扎或硬化治疗。比较42例患者MSCTP和术中直接门静脉造影对食管胃静脉曲张相关侧枝血管显示的差异性。结果MSCTP显示50例食管胃静脉曲张(100%),胃左静脉38例(76%),胃后或胃短静脉17例(34%),胃肾和/或脾肾分流5例(10%),门静脉血栓形成海绵样变5例(10%),2例门静脉和1例脾静脉血栓阻塞部分管腔。42例2种检查方法对食管胃静脉曲张相关侧枝血管显示的差异性检验(χ2=2.00,P>0.05),表明二者无显著差异。结论MSCTP能直观显示食管胃静脉曲张及与之相关的侧枝血管。可明确曲张血管的供血血管,明确是否存在门静脉的血栓及栓塞范围,有助于治疗方案的选择和缩短手术治疗的时间。Objective To investigate the values of multi - slice spiral CT portography （MSCTP） in evaluating the embolization of gas- troesophageal varices preoperatively. Methods 50 patients with portal hypertension accompanying gastroesophageal bleeding underwent 64 - slice spiral CT contrast - enhanced scan, CT data processed by means of MPR,MIP and VR to obtain the images of portal vein system. 42 patients whose varicose vein and its related collateral vessels were clearly demonstrated underwent interventional embolism, while 5 patients with cavernous transformation of portal vein and 3 with partial thrombus in portal vein received endoscopic variceal ligation or sclerotherapy. X2 test was used to detect the differences of MSCTP and direct angiographic portography （DAP） in demonstrating varices and its related collateral vessels. Results The gastroesophageal varices in all 50 cases were showed by MSCTP（ 100% ） , 38 were found having varicosis in left gastric veins（76% ） and 17 in posterior gastric veins（ 34% ） , 5 had gastrorenal or spenorenal shunts（ 10% ） , 5 were found with cavernous transformation （10%） ,2 had partial thrombus in portal vein and 1 had partial thrombus in splenic vein. According tox2 test, MSCTP and DAP had no significant differences in demonstrating varices and its related collateral vessels （χ^2 = 2.00., P 〉 0. 05 ）. Conclusion MSCTP can institutionally demonstrate gastroesophageal varices and its related collateral vessels, and can detect whether there is thrombus and its extent , which makes it easier to select therapeutic regimen and shorten therapeutic time.

关 键 词：体层摄影术 X线计算机 门静脉成像 门静脉高压 静脉曲张 介入放射学 

分 类 号：R814.42[医药卫生—影像医学与核医学] R571.3[医药卫生—放射医学]