肝硬化并食管静脉曲张多层螺旋CT门静脉成像的临床应用  

Clinical application of multi-detector helical computed tomography in esophageal varices with cirrhosis

作　　者：何欣[1,2] 黄仲奎[1] 龙莉玲[1] 彭鹏[1] 李知晓[1] 曾雪明[1] 

机构地区：[1]广西医科大学第一附属医院放射科,广西南宁530021 [2]广西中医学院第一附属医院

出　　处：《实用放射学杂志》2012年第11期1707-1711,共5页Journal of Practical Radiology

基　　金：国家自然科学基金资助项目（30760060）;广西自然科学基金资助项目（桂科自0728155）.

摘　　要：目的研究多层螺旋CT门静脉成像（multi-detector helical computed tomography, MDCTP）评估肝硬化并食管静脉曲张破裂出血（esophageal variees bleeding,EVB）相关危险因素的临床应用价值。方法肝硬化患者行内镜及64层螺旋CT检查，二者诊断结果一致者53例，观测MDCTP中食管静脉曲张的最大直径、分级及类型、胃左静脉直径及开口类型、门静脉及脾静脉直径、脾脏指数大小等指标，并根据患者有无食管静脉曲张出血病史进行统计分析。结果肝硬化并食管静脉曲张破裂出血组与非出血组MDCTP的观察指标中，食管静脉曲张最大直径、分级、胃左静脉直径等指标比较差异有统计学意义（P〈0．05），其中出血组与无出血组食管曲张静脉最大直径分别为（6．9±2．2）mm、（4．9±2．2）mm，95％可信区间分别为6．1～7．8mm、4．0～5．9mm；胃左静脉直径分别为（6．4±1．3）mm、（5．3±1．2）mm，95％可信区间分别为5．9～6．4mm、4．7～5．8mm。食管静脉曲张的类型、胃左静脉的开口类型、门静脉及脾静脉直径、脾脏指数等观察指标比较差异无统计学意义（P〉0．05）。非条件Logistic回归分析结果显示对EVB组影响由大到小依次分别为：胃左静脉直径、食管直径；回归系数分别为：0．696、0．401。结论MDCTP中食管静脉曲张的最大直径及其分级、胃左静脉直径大小与食管静脉曲张破裂出血相关，对预测食管静脉曲张破裂出血有重要意义。Objective To evaluate the value of clinical application of MDCTP in assessing the risk factors of bleeding of esophageal variceal caused by cirrhosis. Methods A total of 53 patients with cirrhosis were confirmed with esophageal varices by both endos- copy and 64-detector helical computed tomography （MDCTP）. Parameters of MDCT were recorded including the maximum diameter of esophageal varices, grades and types, the diameter and opening types of the left gastric vein（LGV）, the diameter of portal vein and splenic vein, spleen index. According to whether there was any history of esophageal variceal bleeding, the patients were divided into two groups and the indicators were analyzed. Results Significant differences of several indicators of MDCTP were observed be- tween bleeding group and non--bleeding group including the largest diameter, grade of esophageal varices and the diameter of LGV （P〈0.05） . For the bleeding and non-bleeding group ： the maximum diameters of esophageal variees were （6.9±2.2） mm , （4.9±2.2） mm,the 95% confidence interval were 6.1--7.8 mm , 4.0--5.9 mm; the diameters of LGV were （6.4±1.3） mm,（5.3±1.2） mm, 95% confidence interval was 5.9--6.4 mm, 4.7--5.8 ram. The types of esophageal varices, the opening types of left gastric vein, the diameters of portal vein and splenic vein, and the spleen index were not significant different between bleeding group and non-bleeding group （P〉 0.05）. Conclusion For MDCTP, the diameter of LGV, the diameter and degrees of esophageal varices were correlated with esophageal varieeal bleeding, which is important to predict the bleeding.

关 键 词：肝硬化 食管胃静脉曲张 计算机体层成像 出血预测 

分 类 号：R575.2[医药卫生—消化系统] R571.3[医药卫生—内科学]