多层螺旋CT及血管容积评估在胃底曲张静脉诊治中的应用

Application of multi-slice spiral CT to assess vascular volume for the diagnosis and treatment of gastric varices

目的利用多层螺旋CT(MSCT)明确肝硬化门静脉高压症患者胃底曲张静脉血管走形情况,辨别流入及流出道;评估测量胃底曲张静脉的血管CT容积与组织胶量之间的关系。方法选取2013年11月—2017年8月入院的肝硬化胃底曲张静脉患者97例,在组织胶治疗前进行MSCT检查,观察曲张静脉的类型及走形情况,并通过Spearman相关性分析及一元线性回归分析评估胃底曲张静脉的CT容积与组织胶用量的相关性。结果MSCT提示Le,g型的比例最高(54.6%),其次为Le、g、Lg型(20.6%)。Le、Lg型及Lgf型各占17.5%、5.2%,Lgf + b型仅为2.1%。MSCT上,胃底曲张静脉走形方向均为从下往上,其中75%的胃底大弯侧曲张静脉合并胃肾分流。胃镜下胃底小弯侧曲张静脉均为由近及远走形,胃底大弯侧曲张静脉由于胃镜下反转镜身时观察角度不同,可发现由近及远(72.7%)或由远到近(20.5%)的血流方向。Spearman相关性分析结果显示组织胶用量与CT容积呈正相关(ρ = 0.89,P < 0.001),一元线性回归方程为Y1 = 0.35+0.65X1,也提示组织胶用量(Y1)与CT容积(X1)呈正相关(R = 0.97,P < 0.001)。结论MSCT可以明确胃底静脉曲张的血管走形,辨别胃底曲张静脉的流入及流出道;而曲张静脉的CT容积与组织胶用量呈正相关,提示治疗前CT容积的测量可作为预测组织胶用量的方法之一。

ObjectiveTo differentiate the inflow and outflow channels of gastric varices in cirrhotic portal hypertension patients using multi-slice spiral CT (MSCT), and to assess the relationship between calculable CT volume of gastric varices and the amount of tissue adhesive.Methods97 cases with cirrhotic gastric varices who were admitted from November 2013 to August 2017 were selected. The type and shape of gastric varices were observed before tissue glue injection treatment by MSCT. The correlation between CT volume of gastric varices and the amount of tissue adhesive was evaluated by Spearman rank correlation coefficient and Univariate linear regression analysis.ResultsMSCT showed that Le, g type had the highest proportion (54.6%), followed by Le, g, Lg (20.6%). Le, Lg and Lgf type accounted for 17.5%, and 5.2%, respectively, while Lgf+b accounted for 2.1%. On MSCT, varices of the gastric fundus were in the direction from bottom to top, and 75% of the fundus had a large curved side varices combined with gastric and renal shunt. Under the gastroscopy, varices in the small curved side of the gastric fundus from near to far were formless. In addition, varices in the large curved side of the gastric fundus when observed from different angles to the direction of blood flow (reverse gastroscope) were 72.7% (near and far) or 20.5 % (far and near). There was a positive correlation between CT volume (R = 0.97, P < 0.001) and the amount of tissue adhesive (Y1 = 0.35 + 0.65X1, Univariate linear regression equation;ρ = 0.89, P < 0.001, Spearman correlation analysis).ConclusionMSCT can recognize the vascular shape and inflow and outflow channels of gastric varices. A positive correlation between CT volume and the amount of tissue adhesive, suggested that the CT volume measurement before treatment could be used as one of the method to predict the amount of tissue adhesive.