经皮脾门静脉核素显像在内镜套扎术疗效评估中的作用

Per-splenic scintigraphy for predicting the result of endoscopic variceal ligation

目的:评价经皮脾门静脉核素显像对肝硬化伴食管静脉曲张患者行内镜下静脉曲张结扎(EVL)治疗前的病例筛选及预后评估的价值。方法:39例肝硬化伴食管静脉曲张患者EVL治疗前进行脾门静脉核素显像检查,根据脾门静脉核素显像侧支血管灌注像,分为Ⅰ组(A1型,单纯上行侧支为主)、Ⅱ组(A2型,上行为主伴完全肝外分流型)及Ⅲ组(C型,上行和下行侧支同时存在)。观察EVL术后3月、1年食管静脉曲张(EV)显效率及复发率。结果:EVL术后1年EV显效率及复发率Ⅰ组分别为38.9%、44.4%;II组分别为9.1%、72.7%;Ⅲ组分别为60%、20%。Ⅲ组EV复发率明显低于Ⅱ组(P<0.05),Ⅰ组虽低于II组,但无统计学意义(P>0.05)。并且EV复发组的门脉分流指数(PSSI)高于非复发组(P<0.05)。提示C型及A1型伴PSSI较低的食管静脉曲张出血患者行EVL疗效满意,复发率低。结论:脾门静脉核素显像可作为EVL术前病例筛选及预后评估安全有效的检查手段。

Objective： To evaluate the value of per-splenic scintigraphy for endoscopic variceal ligation（EVL）. Methods： Thirty-nine patients with liver cirrhosis accompanied by esophageal varices（EV） underwent per-splenic scintigraphy before EVL and were divided into three groups：（ Ⅰ ）to upward collateral vein （type A1）;（ Ⅱ） to upward collateral vein following full-extrahepatic shunt （type A2）;（Ⅲ）to upward and downward collateral vein （type C）. Results： After a following-up of one year, the effective rates of type A1, A2 and C were 38.9%,9.1% and 60% respectively; the EV recurrence rates 44.4%,72.7%,and 20% respectively.The recurrence rate in type C was lower than that in type A2 （P〈0.05）.The portosystemic shant index（PSSI） in EV recrudesce patients was significantly higher than that in EV non-recrudesce patients （P〈0.05）. Conclusion： Per-splenic scintigraphy can be served as guidance in predicting the result of endoscopic variceal ligation.