门脉CT血管造影成像和胃镜在门脉高压诊断中的价值

Values of endoscopy and computed tomographic angiography for portal vein in diagnosis of portal hypertension

目的:了解门脉高压食管胃静脉曲张在门脉CT血管造影成像(CTA)和胃镜上的特点,比较两者对于食管胃静脉曲张的检出正确性.方法:对60例临床疑为门脉高压食管的患者分别行门脉CTA和胃镜检查.所有检查均由消化科和放射科指定专业医师进行操作并作出诊断进行总结分析.结果:门脉CTA、胃镜两种方法检出食管静脉曲张42例和45例,诊断率为70.0%和75.0%,两者的诊断一致率为70.8%.门脉CTA和胃镜两种方法检出的胃静脉曲张分别为52例和30例,诊断率分别为86.7%和30.0%,两者的诊断一致率为26.7%.通过以上的检查和病史分析,60例门脉高压患者均明确了病因,包括肝炎后肝硬化42例,血吸虫性肝硬化7例,酒精性肝硬化3例,胰源性门脉高压7例,门脉海绵样变性1例.结论:门脉CTA对于食管和胃静脉曲张的检出率较高,对胃镜不能观察到的非黏膜面的曲张静脉及其他部位静脉均可作出诊断.对非肝硬化原因的门脉高压亦能作出正确诊断.对疑诊门脉高压的患者,结合门脉CTA和胃镜检查可以对门脉高压病因、病情进行全面的评估.

AIM： To evaluate the clinical efficacy of endoscopy and computed tomographic angiography for portal vein （PV-CTA） in the diagnosis of esophageal-gastric varices caused by portal hypertension. METHODS： A total of 60 patients with suspected portal hypertension were enrolled in this study. All the patients were examined by endoscopy and PV-CTA, and the data were comparatively analyzed. RESULTS： Esophageal varices diagnosed by PV-CTA covered a percentage of 70.0% （n = 42）, while those diagnosed by endoscopy accounted for 75.0% （n = 45）; the coincidence rate was 70.8%. However, for gastric varices, the diagnostic rate of PV-CTA was 86.7% （n = 52 cases）, while that of endosopy was 50.0% （n = 30）; the coincidence rate was 26.7%. The etiology of all 60 cases was defined： 42 cases were with posthepatitis cirrhosis, 7 cases with schistosomal cirrhosis, 3 cases with alcoholic cirrhosis, 7 cases with pancreatic portal hypertension, and 1 case with portal foamy denaturation. CONCLUSION： PV-CTA is efficient in the diagnosis of esophageal-gastric varices, not only for varices in submucosa, muscular layer, serosa, or extraserosa, but also varices caused by non-cirrhosis. Patients with suspected portal hypertension are suggested to be evaluated for portal tension and causes by combination of PV-CTA and endoscopy.