门静脉CTA对孤立性胃静脉曲张内镜下治疗前后的评估

Evaluation of CT partal angiography in isolated gastric varices before and after endoscopic therapy

目的探讨门静脉多层螺旋CT血管造影(CTA)对门脉高压患者门脉系统血管的显示情况及血流动力学改变,判断其在诊断以及内镜下治疗后疗效评估中的价值。方法通过门脉CTA对186例门脉高压的患者进行筛查,对伴有单支流入道的孤立性胃静脉曲张患者行内镜下粘合剂联合硬化剂治疗,治疗后门脉CTA随访,图像重建后通过血管分析软件测量主要血管,包括流入道胃左静脉(LGV)或胃脾分流道(GSS)、门静脉主干(MPV)、肠系膜上静脉(SMV)和脾静脉(SV)的横截面积来观察血流动力学变化。结果筛查出伴有单支流入道的胃静脉曲张患者32例,内镜治疗前主要血管的横截面积:LGV/GSS(89.31±74.10)mm^2,MPV(176.82±64.78)mm^2,SMV(123.89±40.21)mm^2,SV(113.61±56.60)mm^2;治疗后LGV/GSS(71.78±70.33)mm^2,MPV(203.12±64.53)mm^2,SMV(148.55±51.17)mm^2,SV(137.71±57.18)mm^2。治疗前后比较,差异有统计学意义(P<0.05)。结论门脉CTA是一种有效的筛查和内镜治疗后疗效评估的工具,具有重要的临床价值。

Objective To investigate the ability of multi-slice spiral CT portal angiography （CTPA） in demonstrating the vessels of the portal vein system and their hemodynamic changes and its value in diagnosing and assessing effect of endo- scopic therapy for portal hypertension. Methods One hudred and eight-six patients with portal hypertension were involved for screening. The cases of isolated gastric varices with a single afferent vein were selected and underwent endoscopic therapy with tissue adhesives and sclerosing agents. Patients were followed-up by CTPA with an analytic program, which showed the cross-sectional areas of the main vessels （left gastric vein, LGV or gastrosplenic shunt, GSS; main portal vein, MPV; superior mesenteric vein, SMV, splenic vein, SV） and revealed the hemodynamic changes. Results Thirty-two cases of isolated gastric varices with a single afferent vein were selected. The cross-sectional areas of the main vessel before and after endoscopic therapy were as follows .. （before） LGV/GSS （89.31 ± 74.10） mm2 , MPV （ 176.82 ± 64.78） mm2 , SMV （123.89±40.21）mm2,SV （113.61±56.60）mm2; （after） LGV/GSS（71.78±70.33）mm2,MPV（203. 12±64.53）mm2, SMV（148.55 ± 51.17）mm2, SV（ 137. 71 ± 57. 18）mm2. There is a statistically significant difference between the results before and after endoscopic therapy. Conclusion Being an effective screening tool, the portal vein CTA is of great clinical use and value in the assessment of endoscopic therapy.