肝硬化肝内外门-体循环交通的CT表现

CT appearances of intrahepatic and extrahepatic portosystemic shunts in patients with liver cirrhosis

目的探讨肝硬化门静脉高压肝内外门-体循环交通的发生率及CT表现特点。方法回顾性分析80例肝硬化门脉高压患者的肝内外门-体交通的螺旋CT三期扫描表现。结果肝外型门-体循环交通见于79例(98.75%),其中,食管下段黏膜下及食管周围静脉曲张48例(60%),奇静脉和半奇静脉扩张28例(35%),小网膜静脉曲张46例(57.5%),副脐静脉肝外型再通20例(25%),脾肾静脉和胃肾静脉分流10例(12.5%),腹膜后椎旁静脉曲张14例(17.5%);肝内型门-体循环交通6例(7.5%),其中,5例为门静脉左支与副脐静脉交通型(6.25%),1例为门静脉右后支与下腔静脉交通型(1.13%)。结论螺旋CT三期扫描对肝硬化门静脉高压侧支循环的显示有独特的价值,不仅能显示侧支循环的部位、范围和曲张的程度,而且可以追踪血流异常途径。认识侧支循环的CT表现特点,有助于肝内外疾病的鉴别诊断。

Objective To analyze the incidence and CT features of intrahepatic and extrahepatic portosystemic shunts （IEPSS） in patients with liver cirrhosis. Methods The appearances of three phase spiral CT scan in 80 cases of cirrhotic patients with portal hypertension were retrospectively analyzed.Results Extraheptic portosystemic shunts were found in 79 cases （98.75%）, of whom, esophageal submucosal and paraesophageal varices in 48 cases （60%）,azygos and hemiazygos varices in 28 cases （35%）,small omental varices in 46 cases（57.5%）, txtrahepatic para-umbilical vein re-canalization in 20 cases（25%）,splenorenal and gastrorenal shunts in 10 cases（12.5%）, retroperitoneal paraspinal varices in 14 cases（17.5%）,intrahepatic portosystemic shunts were found in 6 cases（7.5%）,of whom ,the left portal and umbilical varices in 5 cases （6.25%）,the right portal vein and the inferior vena cava shunts in 1 case （1.13%）.Conchmion The three-phase spiral CT scans have a peculiar vatue to display the portosystemic shunts which was induced by portal hypertension because it can not only reveal the position,range and extent of the varices but can also track the abnormal flow path so that understanding these CT features are very helpful to differentiate this disease from the intrahepatic and extrahepatic diseases.