MSCT血管成像技术在门静脉高压症中的临床应用价值

Clinical Application of MSCT Angiography in Portal Hypertension

目的探讨多层螺旋CT(MSCT)血管成像技术(MSCT angiography,MSCTA)在门静脉高压症(portal hy-pertension,PHT)诊断及临床治疗中的价值。方法对50例PHT患者者行MSCTA,观察患者门静脉系统的解剖学类型、门静脉主干及其分支侧支循环显示情况;观察食管胃底静脉曲张的形态、位置及血供类型。结果 50例门静脉高压症患者门静脉及侧支循环显影包括:食管下段静脉曲张94.0%,胃底静脉曲张90.0%,胃左静脉曲张90.0%,食管旁静脉曲张72.0%,胃短、胃后静脉曲张32.0%,脾/胃-肾静脉分流28.0%,副脐静脉、腹壁静脉曲张26.0%,腹膜后-椎旁静脉曲张22.0%。对21例患者施行手术,手术与影像学诊断完全符合。MSCTA检出胃静脉曲张(gastric varices,GV)阳性49例所见的病状与胃镜下所见病状对比一致性较好。结论 MSCTA能为PHT患者判断病变程度、预测其并发症及选择治疗方案提供可靠的依据。

Objective To investigate the value of multislice spiral computed tomography angiography（MSCTA） in the diagnosis and treatment of portal hypertension（PTH）.Methods The MSCTA was performed in 50 PHT patients to observe portal vein anatomy,portal-collateral circulation,and the shape,location and blood supply of esophageal varices.Results Among the 50 PHT patients,the demonstration of portal-collateral circulation showed lower esophageal varices in 94.0%,gastrict fundus varices in 90.0%,left gastric varices in 90.0%,paraesophageal varices in 72.0%,short and posterior gastric varices in 32.0%,splenic/gastric vein to renal vein shunt in 28.0%,venae paraumbilicales and abdominal wall varices in 26.0%,and retroperitoneal-paravertebral varices in 22.0%.Twenty-one patients underwent operation,and the surgical diagnosis completely accorded with the imaging diagnosis.The symptoms of 49 GV positive patients detected by MSCTA had good consistency with those found at gastroscopy.Conclusion The MSCTA can provide a reliable basis for determining pathological severity,predicting complications and selecting treatment options in portal hypertension.