MRI指导硬化治疗胃底静脉曲张及早期疗效评价

MRI in guidance for sclerotherapy of gastric varices and evaluation on early treatment response

目的探讨MRI指导胃镜下硬化治疗胃底曲张静脉出血及评价其早期疗效的价值。方法收集73例接受胃镜下硬化治疗胃底静脉曲张出血患者,治疗前应用MRI评估胃底曲张静脉团的范围及其供血、引流途径,并根据MRI估算硬化治疗所需硬化剂用量。治疗后再次行MR检查,比较治疗前后胃底曲张静脉团体积、胃左静脉管径的变化,并比较胃镜与MRI评价疗效的价值。结果治疗前MRI能全面评估曲张静脉团的范围、体积及其供血、引流途径;治疗后MRI示曲张静脉团缩小,胃左静脉管径缩小(P均<0.01)。MRI与胃镜对无效的判断一致,对有效及显效的判断差异有统计学意义(P<0.01)。结论胃底静脉曲张硬化治疗前,MRI评估有助于为出血风险较高患者选择合理治疗方案。应用MRI可观察硬化治疗即时疗效,较胃镜更直观、全面。

Objective To explore the value of MRI in guidance for sclerotherapy of gastric varices bleeding under gastroscopy evaluation on its early treatment response. Methods Totally 73 cases of gastric varices bleeding who received sclerotherapy under gastroscopy were collected. The extent of gastric varices and the blood supply as well as drainage pathways were estimated with MRI. According to MRI, the dosage of curing agent of sclerotherapy was calculated. After sclerother- apy, MR was performed again. Volume of gastric varicose veins and diameter of left gastric vein before and after treatment were compared. Curative effect evaluated under gastroscopy and MRI were compared. Results MRI could comprehensively assessed the extent and volume of gastric varicose vein before treatment, including blood supply and drainage pathways. MRI showed that the volume of gastric varicose veins and diameter of left gastric vein reduced after sclerotherapy （both P 〈0.01）. Between MRI and gastroscopy, the judgments ＂invalid＂ were consistent, but ＂effective＂ and ＂significant effect＂ were significantly different （P〈0.01）. Conclusion Assessment of gastric varices before sclerotherapy with MRI is helpful to choose reasonable treatment for patients having higher risks for hemorrhage. MRI can observe immediate curative effect of sclerotherapy, which is more intuitive and comprehensive than gastroscopy.