CT门静脉成像的临床解剖学分析  

Computed tomographic portal venography in patients with portal hypertension

作　　者：黄金鑫[1] 周主青[1] 尤天庚[1] 杨永康[1] 过欣来[1] 丁涵之[1] 靳晓丽[1] 赵欢[1] 江期鑫[1] 谢燕婷[1] 赵中辛[1] 

机构地区：[1]同济大学附属东方医院胃肠外科,200065

出　　处：《中华肝胆外科杂志》2013年第9期641-644,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：上海市卫生局科研课题资助项目

摘　　要：目的进行CT门静脉成像（computed tomography portal venography，CTPV）的临床解剖学分析，探讨其临床应用价值。方法选取手术组（实验组）40例门静脉高压症合并上消化道出血患者和20例正常对照组进行CTPV临床读片与影像学测量，包括门静脉主干及其主要侧支血管。对胃左静脉的注入方式进行分类总结。应用直线拟合数学模型处理测量数据。结果60例均成功进行CTPV摄片。实验组和对照组门静脉主干直径分别为（16．62±4．80）mm、（10．84±2．14）mm，肠系膜上静脉直径分别为（12．36±2．67）mm、（8．79±1．44）mm，脾静脉直径分别为（14．29±4．24）mrn、（8．32±1．78）mm。实验组胃左静脉大部分注入脾一门交角和脾静脉。直线拟合11／18=X／30数学公式计算显示，阈值压力下门静脉主干X值=18．33mm。胃左静脉食管支的显影率为52．38％、胃左静脉胃支显影率66．67％、胃左静脉食管支及胃支同时显影率23．81％，仍有相当一部分门脉高压患者胃左静脉的胃支和食管支显影不良甚至不显影。腹膜后静脉的显影率为25％。结论应用CTPV在术前对食管胃底周围曲张的门静脉进行形态和功能的详尽评估，指导术者进行区域性断流（regional devascularization，RDV）具有实用价值及临床意义。CTPV显示胃左静脉注入脾门交角和脾静脉的患者临床上出血的风险大。门静脉主干直径≥18mm时可能出血，初步定义为CTPV阈值压力。CTPV在胃左静脉胃支／食管支的精细结构显示上仍然具有一定的局限性。CTPV中提高腹膜后静脉显影率应予关注。Objective To study the use of computed tomographic portal venography （CTPV） in patients with portal hypertension. Methods We selected 40 patients with portal hypertension who presented with upper gastrointestinal hemorrhage as the study group and 20 normal people as the control group. The CTPV images of the individuals were studied. The diameters of the main portal vein and its branches were measured and the patterns of drainage of the left gastric vein were studied. The data were handled using a linear fitting way. Results All 60 patients underwent CTPV successfully. In the study group, the diameter of the main portal vein was （16.62±4.80） mm, the superior mesen teric vein （12.36±2.67） mm, and the splenic vein （14.29±4.24） mm. In the control group, the di ameter of the main portal vein was （10.84 ±2. 14）mm, the superior mesenteric vein （8.79±1.44） mm, and the splenic vein （8.32±1.78） mm. In most cases, the left gastric vein drained into the splenic portal vein and the splenic vein. The diameter of the portal vein X was 18.33 mm under the mathematical axiom 11/18=X/30. The visualization ratio of the esophageal branch of the left gastric vein was 52.38%, the gastric branch 66.67% and these two branches were displayed at the same time in 23.81%. There was non visualization of the left gastric vein in a significant proportion of patients. The visualization ratio of the retroperitoneal vein was 25%. Conclusions CTPV has great values in the clinical application in the pre-operative assessment of patients with esophageal and gastric varices. It gives information on the morphology and function of the portal system which can guide devascular ization procedure. In patients who present with bleeding varices, there is a higher chance that the left gastric vein drains into the splenic-portal vein and splenic vein. The diameter of the main portal vein X ≥18 mm can be used as a threshold value pressure on CTPV imaging. The esophageal/gastric bran- ches of the left gastric vein may not he dis

关 键 词：门静脉高压 门静脉造影 CT 局部血管显影不良 

分 类 号：R816.5[医药卫生—放射医学]