门静脉高压症脾脏循环影像学检查的意义

Significance of Imaging Examination of Splenic Circulation in Portal Hypertension

常规及前列腺素Ｅ_１（ＰＧＥ_１）间接门静脉数字减影血管造影（ＤＳＡ）与彩色多普勒血流显像（ＣＤＦＩ）是检查脾脏循环影像学改变较理想的检查手段。前者对胃左静脉（ＬＧＶ）、胃短静脉（ＳＧＶ）侧支的显示率分别为７８．３％及３９．１％，脾静脉栓塞率为４．３％，脾静脉逆肝血流率为１７．４％。后者对ＬＧＶ侧支及自发脾肾静脉分流侧支的显示率分别为８７％及８３％。脾静脉的血流时间平均速度（ＴＡＶ）为１０．９１±２．９９ｃｍ／ｓ，当ＬＧＶ及ＳＧＶ侧支曲张严重时，贲门周围血管离断术及胃左腔静脉分流术是较合理的治疗方法；当行涉及脾静脉的分流术时，应首先了解脾静脉内有否栓塞；门静脉系统出现逆肝血流时，应有分流术指征。

Routine and prostaglandin E_1(PGF_1)indirect portal vein digital subtraction angiography(DSA)and color Doppler flow imaging(CDFI)are good means for the examination of imageological change in splenic circulation.The former gave the visulization rates of 78.3%and 39.1% for left gastric vein(LGV)and short gastric vein(SGV),respectively.The thrombosis rate of splenic vein was 4.3%.The hepatofugal blood flow rate of splenic vein was 17.4% with the later,the visulization rates of LGV collateral and spontaneous spleno-renal vein shunt collateral were 87%and 83%.The blood flow time average velocity(TAV)of splenic vein was 10.91±2.99 cm/s.When severe varices develope in the collaterals of LGV and SGV,the devasculization and shunt procedure of left gastric vena cava are justifiable,If the splenic vein is involved when performing shunt surgery,it is desirable to check if there is any thrombosis in it.If hepatofugal blood flow occurs in the portal system the shunt operation is indicated.