肝硬化肝内门-体循环交通的CT表现

Intrahepatic Portosystemic Shunts in Patients with Cirrhosis

目的 分析肝硬化门静脉高压肝内门 体循环交通的发生率及CT表现。材料与方法 复习连续 10 0例肝硬化门静脉高压患者 (合并或不合并肝癌 )的增强CT扫描表现 ,统计各部位侧支循环的比例 ,并着重描述肝内门 体循环交通的CT表现。结果 肝内门 体循环交通 4例 (4% ) ,加上另外发现的 2例 ,共 6例 ,均为经肝左内叶门静脉左支脐静脉隐窝部至左内叶或左外叶实质内 ,再与副脐静脉交通的类型。交通静脉均走行于肝左内叶 ,其最大径可达 2 .2cm。 5例合并存在其他部位侧支循环 ,包括食管粘膜下 2例 ,食管和胃粘膜下、食管粘膜下和胃左、脾周和椎旁静脉曲张各 1例。结论 肝内门 体循环交通虽不常见 ,但应引起重视 ,以提高肝内占位病变的鉴别诊断准确性及有助于提示临床医师注意肝性脑病的可能性。

Objective To study the incidence of intrahepatic portosystemic shunts (IHPSS) in patients with cirrhosis and to describe its CT manifestations. Materials and Methods Enhanced CT findings in 100 patients of cirrhosis with portal hypertension, accompanied with or without hepatocellular carcinoma, were carefully reviewed. The sites of the portosystemic collaterals were analyzed.Results Four cases in this series and two in another series of IHPSS were found. In all 6 cases, the shunts were localized between the left portal vein and the umbilical vein, running within the hepatic parenchyma of the medial segment of the left lobe and draining into the paraumbilical vein, with the maximum diameter up to 2.2 cm. In 5 patients other collaterals were demonstrated, including esophageal varices (n=2), esophageal and gastric varices (n=1), esophageal and left gastric varices (n=1) and perisplenic and paraspinal varices (n=1).Conclusion In order to improve the differential accuracy of focal hepatic lesions and to alert the clinician to the possibility of the hepatic encephalopathy, great attention should be paid to IHPSS though it is not a common finding.