CT血管造影成像对门脉高压症胃底静脉曲张分流状态的评估价值  

Value of computed tomography angiography in assessment of shunts associated with gastric fundal varices in patients with portal hypertension

作　　者：吴琼[1] 吴兴旺[2] 许建明[1] 孔德润[1] 

机构地区：[1]安徽医科大学附属第一医院消化内科,安徽省合肥市230001 [2]安徽医科大学附属第一医院影像科,安徽省合肥市230001

出　　处：《世界华人消化杂志》2015年第14期2268-2273,共6页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助项目;No.81271736~~

摘　　要：目的:探讨C T门静脉成像(c o m p u t e d tomography angiography,CTA)在门脉高压合并胃底静脉曲张(gastric fundal varices)患者的分流状态的评估以及治疗方案的选择价值.方法:回顾性分析2011-01/2014-06安徽医科大学附属第一医院诊断门脉高压症患者40例,分别进行内镜以及CTA检查,记录内镜下分型以及CTA血供,测量门脉系统血管直径,记录分流道特点,综合评估分流道状态.相关数据进行进一步统计学分析.结果:40例患者均存在胃底静脉曲张,其中两例CTA提示胃底静脉曲张而胃镜检查未发现.CTA和内镜检查对于曲张胃底静脉的形态对照的一致性检验(Kappa=0.870),差异有统计学意义(P<0.01).GOV2型和IGV型伴胃和/或脾-肾分流的几率较大,达到60.87%.本组病例中,存在胃/脾-肾分流道的19例,门静脉直径平均为1.39 cm±0.25 cm;余无胃/脾-肾分流道形成,门静脉直径的平均值1.56 cm±0.31 cm.其中有5例分流道直径>5 mm患者选择了经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)治疗合并分流道封堵术,患者症状均得到控制.对于无分流道以及分流道直径较小患者使用组织胶治疗胃底静脉曲张,术后观察未有出现组织黏合剂栓塞情况,治疗安全有效.结论:CTA可显示胃底静脉曲张侧枝循环的类型及特点,而分流状态的评估对于该类患者治疗方案的选择以及预后评估有着重要价值.AIM： To assess the value of computed tomography（CT） angiography（CTA） in the evaluation of shunts associated with gastric varices in patients with portal hypertension.METHODS： Forty cirrhotic patients participated in this retrospective study from January 2011 to June 2014 at our hospital. All patients underwent CTA and endoscopy. Endoscopic types and the blood supply revealed by CTA were recorded. The vessel diameter of the portal system and the characteristics of shunts were also recorded. The shunt status was then assessed comprehensively.RESULTS： Of the for ty pa t i ent s who underwent CTA, gastric fundal varices was detected by CTA in all patients, but was not detected by endoscopy in two cases. The two modalities had a significant difference in the detection of gastric fundal varices（Kappa =0.870, P〈0.01）. CTA revealed that GOV2 and IGV types were more likely to have gastric and（or） splenorenal shunts（60.87%）. A total of 19 cases had the presence of gastric/splenorenal shunts, and their mean portal vein diameter was 1.39 cm ± 0.25 cm. In cases without gastric/splenorenal shunts, the mean portal vein diameter was 1.56 cm ± 0.31 cm. The CTA examination found that the shunt diameter of some FVs was larger than 5 mm. Five cases underwent transjugular intrahepatic portosystemic shunt（TIPS） occlusion therapy,and all symptoms were under control. For patients without shunt or with small-diameter shunts, tissue glue injection was given by endoscopy, and no emboli were seen in these patients.CONCLUSION： CTA can display the type and characteristics of collateral circulation of gastric varices, which is of great value for prognosis evaluation and treatment selection.

关 键 词：门脉高压 食管胃底静脉曲张 多排螺旋CT门静脉成像 

分 类 号：R575.2[医药卫生—消化系统]