门静脉高压症患者冠状静脉解剖变异及临床意义

Coronary venous variation in patients with portal hypertension

目的 研究门静脉高压症患者冠状静脉解剖变异、返流情况及临床意义。 方法 采用直接和间接门静脉造影、测压和超声多普勒观察 2 0 0例门静脉高压症患者冠状静脉解剖、门静脉压力和血流。 结果 门静脉高压症患者单支冠状静脉占 79 4 6% ,双支冠状静脉占 2 0 5 4 % ,开口于门静脉主干、脾静脉和门脾静脉交汇处分别为 62 3 3 %、2 7 3 5 %和 8 0 7% ,出血和断流术后再出血患者冠状静脉开口主要位于门静脉主干 ,顽固性腹水无出血者多数位于脾静脉 ;间接门静脉造影示Ⅱ、Ⅲ级、门静脉血栓和活动性出血患者冠状静脉显示率分别为 2 6 19%、5 6 64 %、10 0 %和 10 0 % ,出血静止期和无出血顽固性腹水者分别为 4 7 79%和 19 0 5 %。 结论 冠状静脉解剖变异是影响食管静脉曲张出血的重要因素 ,返流是出血的重要标志。

Objectives To observe the changes in the anatomic variation and the hepatofugal flow of coronary vein and to evaluate the clinical significance of these changes in patients with portal hypertension. Methods The anatomic variations and the retrograde flow of the coronary vein, and the portal antegrade flow and the portal pressure were observed by direct and indirect portography, direct measurement of portal pressure and Doppler sonography in 200 cirrhotic patients with portal hypertension. Results Single branch and two branches of the coronary vein were noted in 79 46% and 20 54% of the patients with portal hypertension respectively by direct portography. The sites of coronary vein arising from the portal vein, splenic vein or portosplenic junction were found in 62 33%, 27 35% or 8 07% respectively. The confluence of coronary vein and portal vein was found in most patients with variceal bleeding and recurrent bleeding after devascularization. The confluence of the coronary vein and splenic vein was observed in most patients with refractory ascites without variceal bleeding.Arterial portography demonstrated retrograde opacification of the coronary vein in 26 19% (grade Ⅱ portal venous pattern),56 64% (grade Ⅲ portal venous pattern ),100% (portal thrombosis and action bleeding) 47 79% (controuing periods of bleeding), and 19 05% (refractory ascites). Conclusions The anatomic variation of the coronary vein may be related to variceal bleeding in cirrhotic patients with portal hypertension and the retrograde opacification of the coronary vein is a significant sign of variceal bleeding.