门静脉高压症食管旁静脉的CT检查解剖特征及临床意义  

CT examination anatomical features and clinical significance of paraesophageal vein in portal hypertension

作　　者：田明国[1] 卜阳 丁荣华[2] 陈大治[3] 杨勇[1] 刘明奇 吴金花[3] Tian Mingguo;Bo Yang;Ding Ronghua;Chen Dazhi;Yang Yong;Liu Mingqi;Wu Jinhua(Department of Hepatobiliary Surgery,People's Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;Department of Infectious Disease,People's Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;Department of Medical Imaging Center,People's Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China)

机构地区：[1]宁夏回族自治区人民医院肝胆外科,银川750002 [2]宁夏回族自治区人民医院感染科,银川750002 [3]宁夏回族自治区人民医院医学影像中心,银川750002

出　　处：《中华消化外科杂志》2022年第2期295-302,共8页Chinese Journal of Digestive Surgery

基　　金：宁夏回族自治区重点研发计划项目(2017BY036)。

摘　　要：目的探讨门静脉高压症患者食管旁静脉的CT检查解剖特征及临床意义。方法采用回顾性描述性研究方法。收集2018年1月至2021年6月宁夏回族自治区人民医院收治的173例门静脉高压症患者的临床资料;男124例, 女49例;中位年龄为47岁, 年龄范围为22~71岁。观察指标:(1)术前CT检查情况。(2)手术情况。(3)随访情况。采用门诊随访, 术后6个月内, 每3个月随访1次, 之后每6个月随访1次, 了解患者手术疗效。随访时间截至2021年6月。偏态分布的计数资料以M(范围)表示。计数资料以绝对数表示。结果 (1)术前CT检查情况:门静脉高压症患者食管旁静脉CT检查显示率为52.60%(91/173)。173例患者中, 82例未显示食管旁静脉, 91例显示存在食管旁静脉。91例显示存在食管旁静脉的患者中, 食管旁静脉曲张46例, 粗食管旁静脉24例, 细食管旁静脉21例。91例显示存在食管旁静脉的患者中, 无食管静脉曲张(EV)8例, 合并EV 83例。83例合并EV患者中, 食管旁静脉单独汇入奇静脉或半奇静脉44例, 膈肌上形成食管旁静脉曲张并与EV 汇合后共同汇入奇静脉39例。(2)手术情况:173例患者顺利完成手术, 其中单纯脾切除术8例, 脾切除联合改良彻底断流术86例, 脾切除联合重建自发性胃肾分流断流术35例, 脾切除联合保留食管旁静脉断流术41例, 脾切除联合食管旁静脉环缩术3例。173例患者无手术死亡, 67例发生并发症(3例单纯脾切除术、29例脾切除联合改良彻底断流术、11例脾切除联合重建自发性胃肾分流断流术、23例脾切除联合保留食管旁静脉断流术、1例脾切除联合食管旁静脉环缩术)。(3)随访情况:173例患者中, 159例获得随访, 随访时间为6~42个月, 中位随访时间为28个月。7例单纯脾切除术获得随访患者中, 无EV 6例, EV复发1例。79例脾切除联合改良彻底断流术获得随访患者中, 无EV 5例, EV轻、中度残留67例, EV重Objective To investigate the computed tomography(CT)examination anato-mical features and clinical significance of paraesophageal vein(PEV)in portal hypertension.Methods The retrospective and descriptive study was conducted.The clinical data of 173 patients with portal hypertension who were admitted to the People's Hospital of Ningxia Hui Autonomous Region from January 2018 to June 2021 were collected.There were 124 males and 49 females,aged from 22 to 71 years,with a median age of 47 years.Observation indicators:(1)preoperative CT examinations;(2)surgical situations;(3)follow-up.Follow-up was conducted using outpatient examination to detect surgical effects once every 3 months within postoperative 6 months and once every 6 months after postoperative 6 months.The follow-up was up to June 2021.Measurement data with skewed distribution were represented as M(range)and count data were described as absolute numbers.Results(1)Preoperative CT examinations.The CT detection rate of PEV in the 173 portal hyper-tension patients was 52.60%(91/173).Of 173 patients,82 cases were negative with PEV and 91 cases were positive with PEV.Of the 91 patients who were positive with PEV,there were 46 cases with paraesophageal varices,24 cases with thick PEV,21 cases with thin PEV,8 cases without esophageal varices and 83 cases accompanied with esophageal varices.Of the 83 patients who were accom-panied with esophageal varices,there were 44 cases with PEV converged alone with azygos vein or semiazygos vein,39 cases with paraesophageal varices formed above the diaphragm confluent with esophageal varices into azygos vein.(2)Surgical situations.All the 173 patients underwent surgery successfully,including 8 cases undergoing splenectomy,86 cases undergoing splenectomy combined with modified complete devascularization,35 cases undergoing splenectomy combined with spontaneous gastrorenal shunt reconstructing devascularization,41 cases undergoing splenectomy combined with PEV preserving devascularization and 3 cases undergoing splenectomy combin

关 键 词：高血压 门静脉 食管旁静脉 穿静脉 食管静脉曲张 改良彻底断流术 环缩术 

分 类 号：R575.2[医药卫生—消化系统]