肝硬化门静脉高压患者食管静脉曲张CT表现预测首次上消化道出血的价值

CT findings of esophageal varices in cirrhotic patients with portal hypertension predict the risk of bleeding from the upper gastrointestinal tract for the first time

目的观察肝硬化门静脉高压患者食管静脉曲张的CT表现,并对首次上消化道出血的风险进行预测。方法选取延安大学附属医院肝硬化患者,根据是否存在门静脉高压,是否有门静脉高压并发食管静脉曲张破裂致上消化道出血进行分组,全部患者进行CT扫描,对静脉截面数量、门静脉主干、门静脉左支、门静脉右支、胃底静脉的直径进行测量。结果肝硬化门静脉高压患者中有63.1%患有食管静脉曲张,这些患者中有86.8%出现上消化道出血,无食管静脉曲张者仅9.7%出现上消化道出血。食管静脉曲张组较对照组静脉截面数多,门静脉主干、门静脉左支、门静脉右支和胃底静脉的直径均大于对照组(P<0.05)。食管静脉曲张组出血者的静脉截面数多于未出血者,出血者门静脉主干、门静脉左支、门静脉右支和胃底静脉的直径均大于未出血者(P<0.05)。结论门静脉高压是肝硬化发展的一个主要危险因子,可引发食管静脉曲张,导致上消化道出血。在临床中,可以用肝硬化门静脉高压食管静脉曲张患者的CT图来预测上消化道出血。

Objective To investigate the CT findings of esophageal varices in patients with cirrhosis and portal hypertension,and to predict the risk of bleeding from the upper gastrointestinal tract for the first time. Methods Cirrhosis patients in the Affiliated Hospital of Yan＇an University were selected. Based on the presence or absence of portal hypertension,whether there was a portal hypertension complicated with esophageal varices rupture caused hemorrhage of upper digestive tract were divided into different groups. All patients for CT scanning,the number of venous cross section,portal vein,the left branch of the portal vein,the right branch of the portal vein,gastric fundus vein diameter were measured. Results Esophageal varices were present in 63. 1% of cirrhotic patients with portal hypertension,with an upper gastrointestinal bleeding of up to 86. 8% in these patients,only 9. 7% of the patients withont esophageal varices had upper gastrointestinal bleeding. Compared with the control group,the number venous aross section was more in esophageal varices group,portal vein,the left branch of the portal vein,the right branch of the portal vein,gastric fundus vein diameter were larger（P〈0. 05）. The number of venous sections,portal vein,the left branch of the portal vein,the right branch of the portal vein and gastric fundus vein diameter were more in patients with esophageal vances bleeding than those of without hemorrhage（P〈0. 05）. Conclusion Portal hypertension is a major risk factor for the development of cirrhosis,which can lead to esophageal varices,cause the digestive tract hemorrhage. In clinic,CT in patients of liver cirrhosis with portal hypertension and esophageal varices can predict upper gastrointestinal bleeding.