内镜治疗食管胃静脉曲张前后门体侧支循环的变化

Observation on hemodynamic changes of the portosystemic collaterals before and after endoscopic treatment in patients with gastroesophageal varices

目的 比较肝硬化胃食管静脉曲张（GEV）患者内镜治疗前后门体侧支循环的变化,评价内镜治疗前伴或不伴食管旁静脉曲张（Para-EV）及非静脉曲张门体分流与内镜治疗疗效的关系.方法 2007年1月至2009年12月期间在内镜中心行食管静脉曲张套扎（EVL）＋胃静脉曲张组织胶注射（EBC）治疗的肝硬化食管胃静脉曲张患者26例.在治疗前1周及治疗后1年内进行64排螺旋CT门脉成像检查,观察门脉系统侧支血管在内镜治疗前后的变化情况.结果 胃左静脉平均直径在内镜治疗后显著减小[（6.7±1.9）mm比（5.0±1.9）mm,P＜0.05].治疗前GEV伴Para-EV与不伴ParaEV的内镜治疗有效率差异无统计学意义（80.0%比72.7%,P＞0.05）.治疗前GEV伴非静脉曲张门体分流与不伴非静脉曲张门体分流的内镜治疗有效率差异无统计学意义（82.4%比66.7%,P＞0.05）.结论 多排螺旋CT门脉成像可以为GEV的治疗方案选择及评价预后提供重要信息.

Objective To investigate the hemodynamic changes of protosystemic collaterals before and after endoscopic treatment in patients with gastroesophageal varices using 64-row multidetector computed tomograghy portal venography （MDCTPV） so as to evaluate the efficacy of endoscopic treatment in patients with or without para-esoghageal varices and with or without nonvarices portosystemic collaterals before treatment. Methods Twenty-six patients with gastroesophageal varices, who underwent endoscopic variceal ligation （EVL） for esophageal varices and endoscopic N-butyl-2-cyanoacrylate injection （EBC） for gastric varices between Jan.2007 and Dec. 2009, were enrolled. Sixty four-row MDCT was used to examine the changes of portosystemic collaterals 1 week before and 12 months after endoscopic treatment. The reconstructed images of portosystemic collaterals before and after endoscopic treatment were evaluated. Results Excellent quality of portosystemic collateral vessels on CTPV were obtained in all patients. The mean diameter of left gastric vein decreased from （6.7±1.9） mm to （5.0±1.9） mm after endoscopic treatment,with significant difference （P〈 0.05）. There was no significant difference in outcomes between patients with or without para-esoghageal varices （80% vs 72.7%, P〉0.05） and patients with or without non-varices portosystemic collaterals （82.4% vs 66.7% ,P〉0.05）. Conclusions Sixty fourrow MDCTPV may provide important information for option of endoscopic treatment and prognosis.