CT 门静脉成像诊断胃底静脉曲张侧支循环的价值

CT 门静脉成像诊断胃底静脉曲张侧支循环的价值
赵丽琴 贺文 赵红 于永征
【摘要】 目的 探讨CT 门静脉成像( CTPV) 在胃底静脉曲张( GV) 诊断中的价值。
方法 回顾性分析经内镜证实的40 例肝硬化患者GV 的CTPV 类型、程度及血供特点, 并与内镜曲张
静脉的形态、部位相对照。结果 GV 的形态在胃镜上分为迂曲形、结节形和瘤形, CTPV 上相应为迂
曲状、结节状和瘤状, 胃镜下GV 的形态为迂曲形21 例, CTPV 表现为迂曲状19 例, 结节状2 例; 胃镜
下结节形14 例中, CTPV 上表现为迂曲状1 例, 结节状13 例; 胃镜下瘤形5 例, CTPV 均表现为瘤状。
2 种方法对GV 形态对照的一致性检验( Kappa = 0. 873, P < 0. 01) , 有明显统计学意义; GV 在胃镜上
的部位与其形态及CTPV 的血供有明显的对应关系, 食管-胃静脉曲张1 型( GEV1 ) , GV 多为迂曲形
( 19 /25) , CTPV 的血供主要为胃左静脉( LGV) 单独或为主供血( 21 /25 ) ; 食管-胃静脉曲张2 型
( GEV2) GV 主要为结节形( 5 / 7) , CTPV 的血供为LGV 及胃后静脉( PGV) 和( 或) 胃短静脉( SGV) 均
参与GV 的供血, 以后者居多( 5 /7 ) ; 孤立性胃静脉曲张( IGV) 型GV 的形态为结节形( 4 /8) 和瘤形
( 3 /8) , 以PGV 和( 或) SGV 单独或为主供血( 8 /8 ) 。此外, GEV2 型和IGV 型伴胃和( 或) 脾肾分流
的几率较大( 5 /7、6 /8) 。结论 CTPV 可无创性地显示胃底静脉曲张侧支循环的类型、特点, 对临床
治疗方案的选择及预后的评估有重要价值。
【关键词】 肝硬化; 高血压, 门静脉; 食管和胃静脉曲张; 体层摄影术, X 线计算机
The value of CT portal venogr aphy in the dia gnosis of collateral veins in patients with gastric var ices
ZHAO Li-qin* , HE Wen, ZHAO Hong, YU Yong-zheng. * Department of Radiology, Beijing Friendship
Hospital Affilia ted of Capital University of Medica l Science, Beijing 100050, China
Corresponding author: HE Wen, Email: hewen1724@sina. com
【Abstra ct 】 Objective To investigate the types and characteristics of gastric varices ( GV) on CT
portal venography ( CTPV) and its correlation with endoscopic findings. Methods Forty patients with
hepatocirrhosis were analyzed retrospectively . The gastric varices′types, degrees, and extension on CTPV
were studied in relation to the endoscopics′findings. Result s The shapes of gastric varices on CTPV had
three types : circuity, nodosity and nubbly, which were highly correlated with the findings of the endoscopics
( K = 0. 873, P < 0. 01 ) . Among the 21 cases of gastric varices with endoscopic appearance of circuity,
19 of them had the same appearance, 2 of them with the appearance of nodosity on CTPV. There were
14 cases with nodosity appearance on endoscopy, 13 cases had nodosity and 1 had circuity on CTPV. And
there were 5 cases whose GV shape were nubbly on both endoscopy and CTPV. The location of GV on
endscopy was related to its shapes on endoscopy and the blood supply of GV on CTPV. Ingastroesophageal
varices typeⅠ( GEV1) , the shapes of mostGV were circuity( 19 /25) , and the blood supply was often derived
from the left gastric veins ( LGV) ( 21 / 25) . In gastroesophageal varices type Ⅱ( GEV2) , the shapes were
mainly nodosity( 5 /7) and the blood supply could come from both LGV and post and( or) short gastric veins,
and oftencame from the latter( 5 /7) . In isolated gastric varices ( IGV) , its shapes were nodosity( 4 /8) and
nubbly( 3 /8) , and it often came from the post and( or) short gastric veins( 8 /8) . The gastrorenal and( or)
splenorenal shunt was tend to occur in GEV2 and IGV type ( 4 /8, 3 /8 ) . Conclusion CTPV is an noninvasive
methods , which can reveal the gastric varices and the types of porto-systemic corralation. It is of
important value in the selection of therapy and the evaluation of prognosis.
【Key wor ds】 Cirrhosis; Hypertension, portal; Esophageal and gastric varices; Tomography,
X-ray computed

CT 门静脉成像诊断胃底静脉曲张侧支循环的价值--腹部.rar