经皮脾门静脉核素显像、B超及胃镜对肝硬化门脉高压诊断价值的对比研究

Dignostic value of splenoportoscintigraphy,gastroscopy and B-mode ultrasonography for liver cirrhotics with portal hypertension.

为探讨经脾门静脉核素显像、胃镜及 B超检查在肝硬化门脉高压诊断中的价值及其相关性 ,采用99m 锝 -植酸钠 (99m Tc- Phytate)经脾细针穿刺给药法对 5 8例肝病与非肝病患者进行了经脾门静脉单光子发射计算机断层 (SPECT)显像 ,以观察及门脉循环情况 ,计算门体分流指数 (PSSI) ,并与胃镜、B超进行比较。结果显示 ,经脾门静脉核素显像可将肝硬化门脉高压分为四型 ,即无分流型、有分流型 (包括肝内、外分流 )、有侧支循环型、完全肝外分流型。 PSSI值非肝病对照组为 0 .192± 0 .0 6 8,慢性肝病组为 0 .2 46± 0 .0 5 7,肝硬化门脉高压组为0 .5 41± 0 .0 82。按肝硬化 Child A、B、C分级 ,三组分别为 0 .384± 0 .0 5 2、0 .5 2 3± 0 .0 72、0 .6 80± 0 .0 81。若以 PSSI>0 .36为判别阈 ,肝硬化组总阳性率为 91.7% ,其诊断价值明显优于 B超及胃镜。提示经脾门静脉核素显像既能显示脾门静脉形态及侧支循环 ,又能测定 PSSI,有助于肝硬化的早期诊断、治疗选择及预后判断。

To investigate and evaluate the methods for the dignosis of cirrhotics with portal hypertension.Spleno-portal vein shape and portosystemic shunt index(PSSI)were determined through portal circulation imaging by using intrasplenic injection of 99m Tc-Phytate.Comparision was also made with gastroscopy and ultrasonography.Results showed that the liver cirrhostics with portal hypertension were separated into four type,namely nonshunt,shunt,with collateral vein and full-extrahepatic shunt type by splenoportoscintigraphy. The PSSI for controls was 0.192±0.068,chronic hepatitis was 0.246±0.057,cirrhosis was 0.541±0.082,cirrhosis Child-pugh A 0.384±0.052,B 0.523±0.07,C 0.680±0.081.If the threshold for cirrhosis was set at PSSI>0.36,the sensitivity was 91.7%,superior to the above other methods.It suggests that splenoportoscintigraphy is capable showing splenoportal circulation shape and helpful in dignosing cirrhosis at its early stage and evaluating prognosis.