肝移植术前超声和螺旋CT门静脉成像检查对诊断门静脉栓塞的准确率

Assessment of portal vein embolism in the liver transplant candidates： comparison of ultrasound and spiral CT portography

目的探讨肝移植术前超声和螺旋CT门静脉成像（SCTP）检查对诊断门静脉栓塞的准确率。方法135例肝移植受者在术前分别接受了超声、SCTP以及超声联合SCTP检查，对其中31例怀疑有门静脉栓塞的受者同时进行了超声造影检查，并对受者的门静脉栓塞情况及栓子性质进行初步诊断；以肝移植术中和术后病肝的解剖和组织病理学检查为门静脉栓塞和栓子性质的诊断标准。将肝移植术前经各项检查得出的门静脉栓塞例数及栓子性质的诊断结果与术中和术后的诊断标准进行对比分析，评估术前各项检查的诊断准确率。结果超声检查对诊断门静脉栓塞的准确率为91．1％（123／135），SCTP检查为86．7％（117／135），超声和SCTP联合检查为95．6％（129／135），联合检查显著高于单一检查（P〈0．05）。超声造影对门静脉内栓子的定性诊断的准确率为100％，显著高于超声检查（58．6％）和SCTP检查（73．9％，P〈0．05）。结论肝移植术前超声和SCFP检查对诊断门静脉栓塞均有较高的准确率，两者联合检查的准确率更高；超声造影可明确门静脉内栓子的性质。

Objective To investigate the accuracy of ultrasound and spiral CT portography in detecting portal vein embolism in the liver transplant candidates. Methods One hundred and thirty-five patients before liver transplantation, underwent ultrasound and spiral CT portography. Among them, 31 patients were subjected to contrast-enhanced uhrasonography. Results The accuracy of ultrasound and spiral CT portography in detecting portal vein embolism was 91. 1% （123/135） and 86. 7 % （117/135）, respectively. Co-examination improved the accuracy （96. 5 %） （P〈0. 05）. The accuracy of contrast-enhanced ultrasound to differentiate between benign and malignant portal vein thrombosis was 100 %, which was higher than that of ultrasound （58.6 %）, and spiral CT portography （73.9 %） （P〈0. 05）, respectively. Conclusions Both ultrasound and spiral CT portography had high accuracy in the diagnosis of portal vein embolism, and the accuracy of co-examination was higher. contrast-enhanced ultrasonography could differentiate portal vein blood thrombosis from tumor thrombosis, and give more information.