门静脉高压自发性分流患者食管胃底静脉曲张特点

Comparison of characteristics of esophageal gastric varices in portal hypertension patients with and without spontaneous shunts

目的：了解门静脉高压自发性分流患者门静脉及食管胃底静脉曲张的特点。方法：回顾性分析2012年1月至2015年8月间均行门静脉CT血管造影成像和胃镜检查诊断为食管胃底静脉曲张的118例患者的临床资料。结果：门静脉CT血管造影成像检查发现，存在脾—肾或胃—肾分流患者24例（分流组）、无上述分流患者94例（无分流组）。分流组门静脉直径为（12.48±2.79） mm，无分流组门静脉直径为（13.58±3.46） mm，两组差异无统计学意义（ P＞0.05）。分流组胃底曲张静脉面积为294.00（0.00～2400.00） mm2，显著大于无分流组[26.00（0.00～1620.00）mm2， P＜0.001]。分流组与无分流组食管静脉曲张范围及严重程度分布差异均有统计学意义，分流组食管静脉曲张范围小、程度较轻。无论有无消化道出血史，分流组的胃底静脉面积均大于无分流组（ P＜0.05）；无内镜治疗史的患者中，分流组的胃底静脉面积大于无分流组（ P＜0.001）；无脾切除治疗史的患者中，分流组的胃底静脉面积大于无分流组（ P＜0.001），分流组的门静脉直径小于无分流组（P＜0.05）；Child-Pugh A、B级的患者中，分流组胃底静脉面积均大于无分流组（均P＜0.05）。结论：门静脉高压自发性分流且未接受脾切除手术的患者具有更小的门静脉直径，食管静脉曲张程度较轻；自发性分流患者内镜表现有较大扭曲的胃底曲张静脉。

Objective： To compare the characteristics of esophageal gastric varices in portal hypertension patients with and without spontaneous shunts.Methods：Clinical data of 118 patients with esophageal gastric varices undergoing portal vein computed tomographic angiography （ CTA ） and gastroscopy between January 2012 and August 2015 was retrospectively reviewed.Results： Portal vein CTA results showed that spleno-renal or gastro-renal shunts were detected in 24 out of 118 cases.The average portal vein diameters （ PVD ） of patients with and without spontaneous shunt were （12.48 ±2.79） mm and （13.58 ±3.46） mm, respectively（P〉0.05）.The average area of gastric veins in patients with spontaneous shunt was significantly larger than that of patients without shunt[294.00（0.00~2400.00） mm2 vs.26.00（0.00~1620.00） mm2 ,respectively, P〈0.001] .Compared with patients without spontaneous shunt, the location of esophageal varices was lower and the degree was less serious in patients with spontaneous shunt（ P〈0.05） .No matter with history of uppergastrointestinal bleeding, the average area of gastric veins in patients with spontaneous shunt was significantly larger than that of patients without shunt （ P〈0.05） .For patients having no history of splenectomy, the average portal vein diameter （ PVD） in those with spontaneous shunt was significantly smaller than that in those without shunt （P〈0.05）.Conclusion：The portal vein diameter of patients without splenectomy and with spontaneous shunts is shorter and their esophageal varices are less serious; the gastric veins are large and wriggly in patients with spontaneous shunts.