磁共振血管造影在评价门静脉高压症患者断流手术效果中的价值

Magnetic resonance angiography in assessing changes of pre and post disconnective portal system in patients with portal hypertension

目的 探讨磁共振血管造影在评价对于门静脉高压症患者行脾切除加贲门周围血管离断术手术效果中的价值。 方法 15例门静脉高压症患者行脾切除加贲门周围血管离断术 ,分别在术前 1周、术后 2周采用Siemens 1 5T磁共振仪测定门静脉直径、侧支循环、曲张静脉和门静脉主干流速及流量的改变。 结果 门静脉高压症患者术后 2周门静脉主干直径明显变小 ,胃底曲张静脉、食管曲张静脉和食管支、高位食管支术后复查均消失或明显改善 ;术后门静脉血流速度、血流量比术前降低 ;15例患者中 9例患者术后胃体显影强度增加。 结论 磁共振血管造影对于门静脉高压症患者的门静脉系统显影良好 ,并可进行血流动力学的客观评价 ,在无创性评价手术效果和预测患者预后中有重要的价值 ;术后胃体静脉性充血增加可能是断流术后门静脉高压性胃病增加的重要原因。

Objective To evaluate the role of magnetic resonance angiography (MRA) in assessing the portal system changes in patients with portal hypertension after pericardial devascularization and splenectomy. Methods The portal diameter, blood velocity and flow, collateral circulation, variceal vein and other portal parameters of 15 patients with portal hypertension receiving pericardial devascularization and splenectomy and splenectomy were comparatively evaluated with Siemens 1 5 T MRI 1 week before operation and 2 weeks after operatiion. Results The portal diameters decreased after operation, with the disappearance or alleviation of esophageal and fundal variceal veins.In 15 patients, 9 showed. The blood velocity and flow of the portal veins were lower postoperatively. than those preoperatively; In 15 patients, 9 showed increased gastric imaging intensity after operation. Conclusions MRA can provide high quality and concrete 3 diamensional information about the portal system and hemodynamics of portal hypertensive patients. It is an important non invasive way in evaluating the effects of operations and long term follow up. Postoperative gastric venous congestion possibly causes increased portal hypertensive gastropathy after disconnection.