CT门静脉成像在急诊TIPS治疗EGVB患者中的应用  

Application of CT Portal Venography in Emergency TIPS Treatment of EGVB Patients

作　　者：钱其林 QIAN Qilin(The Second Affiliated Hospital of University of South China,Hengyang 421001,China)

机构地区：[1]南华大学附属第二医院,湖南衡阳421001

出　　处：《中外医学研究》2023年第27期65-69,共5页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:探讨CT门静脉成像(CTPV)在急诊经颈静脉肝内门体分流术(TIPS)治疗食管胃底静脉曲张出血(EGVB)患者中的应用。方法:回顾性分析2020年1月—2023年1月南华大学附属第二医院收治的97例急诊TIPS治疗EGVB患者的临床资料。所有患者均进行CTPV及胃镜检查、TIPS。统计所有患者治疗情况并分析典型病例,分析胃镜检查与CTPV检查诊断食管胃静脉曲张分型、分级的一致性。结果:97例患者入院后24 h内均成功完成TIPS,在TIPS后成功止血,止血率为100%。患者术后均未出现肝衰竭、失血性休克等严重并发症。97例患者术前CTPV检查均显示EGVB阳性,且术中均经数字减影血管造影检查证实。患者门静脉压力梯度由术前(23.08±5.38)mmHg下降至(11.02±3.05)mmHg,差异有统计学意义(t=19.206,P<0.001)。CTPV检查、胃镜检查诊断食管胃静脉曲张分型的一致性一般,一致率为86.60%。CTPV检查与胃镜检查诊断食管胃静脉曲张分级的一致性一般,一致率为90.72%。结论:CTPV对EGVB分型及分级的诊断与胃镜相一致,能够准确、全面、无创性对患者疾病病情进行评估,从而为急诊TIPS的顺利进行提供依据。Objective:To investigate the application of CT portal venography(CTPV)in emergency transjugular intrahepatic portosystemic shunt(TIPS)treatment of esophageal-gastro varices bleeding(EGVB)patients.Method:The clinical data of 97 patients with EGVB treated with emergency TIPS in the Second Affiliated Hospital of University of South China from January 2020 to January 2023 were retrospectively analyzed.CTPV examination,gastroscopy and TIPS were performed in all patients.The treatment status of all patients was counted and typical cases were analyzed.The consistency of gastroscopy and CTPV examination in the diagnosis of esophageal and gastric varices classification and grading was analyzed.Result:All 97 patients successfully completed TIPS within 24 h after admission,and successfully hemostasis after TIPS,with a hemostasis rate of 100%.None of the patients had serious complications such as liver failure and hemorrhagic shock etc.All 97 patients were EGVB positive by preoperative CTPV examination,which was confirmed by digital subtraction angiography examination during operation.The pressure gradient of portal vein decreased from(23.08±5.38)mmHg to(11.02±3.05)mmHg,the difference was statistically significant(t=19.206,P<0.001).There was general consistency between CTPV examination and gastroscopy in the diagnosis of esophageal and gastric varices classification,and the consistency rate was 86.60%.There was a general consistency between CTPV consistency and gastroscopy in the diagnosis of esophageal and gastric varices grading,and the agreement rate was 90.72%.Conclusion:The diagnosis for classification and grading of EGVB by CTPV is consistent with gastroscopy,and can accurately,comprehensively,and non-invasive evaluate the patient's disease condition,thus providing a basis for the smooth progress of emergency TIPS.

关 键 词：CT门静脉成像 肝硬化 食管胃静脉曲张出血 肝内门体分流术 诊断 分级 

分 类 号：R575.2[医药卫生—消化系统]