门脉CTA及内镜对胃静脉曲张诊断及疗效评估的比较研究

A comparative study on the diagnosis and the therapeutic evaluation of gastric varices between CT portal angiography and endoscopy

目的探讨多层螺旋CT血管造影(门脉CTA,简称CTPA)在诊断门脉高压胃静脉曲张及内镜下胃静脉曲张黏合剂联合硬化剂治疗疗效评估中的作用。方法对20例内镜下证实存在胃静脉曲张的患者予以黏合剂联合硬化剂治疗,治疗前后分别进行多层螺旋CT血管门脉造影检查。结果20例门脉CTA检查均发现胃静脉曲张。GOV-1型门脉CTA示血流来源以胃左静脉为主,GOV-2型则由胃左静脉、胃短/胃后静脉混合供血,IGV-1型以胃短/胃后静脉供血为主,此型分流发生率较高。经内镜下黏合剂联合硬化剂治疗,孤立性瘤状胃静脉曲张(IGV-1型)10例,总体有效率为90.00%,而非孤立性瘤状胃静脉曲张(GOV-1型和GOV-2型)9例,总体有效率为44.45%。结论门脉CTA能准确、直观、立体地显示血管解剖特点,为门脉高压胃静脉曲张的诊断、治疗方案的选择提供重要依据,并且可作为评估内镜下胃静脉曲张黏合剂联合硬化剂治疗疗效的一种重要手段。

Objective To investigate the diagnosis of portal hypertension and gastric varices（GV） by CT portal angiographies and to evaluate the efficacy of endoscopically the sclerotherapy of adhesives combined with sclerosants in gastric varices. Method Twenty patients with gastric varices were endoscopically diagnosed and treated with adhensives and sclerants. All of them underwent CT portal angiography before and after the treatment. Results The CT portal angiography revealed all the patients had the gastric varices. According to Sarin＇ s category of GV, gastroesophageal varices GOV-1, in which the predominant route to form the varices was the left gastric vein. GOV-2, in which the left gastric vein and the posterior/short gastric veins contributed to the formation of the varices. Isolated gastric varices IGV-1, in which posterior/short gastric veins were the major contributors to form the varices and the rate of gastorenal shunt was relatively high. After the endoscopically the sclerotherapy of adhesives combined with sclerosants, the overall efficient rate was 90.00% in 10 patients with IGV-1 and 44.45% in 9 patients with GOV-1 or GOV-2. Conclusions The CT portal angiography is considered as a routine method for detecting and assessing portosystemic collaterals. It is also useful for selecting patients as candidates, and for evaluating the therapeutic results.