肝、胰源性门静脉高压侧支循环开放情况的对比研究

Comparison of collateral circulation opening status in hepatic and pancreatogenic portal hypertension

目的比较肝源性门静脉高压(HPH)与胰源性门静脉高压(PPH)侧支循环开放的差异,以指导临床进行合理治疗。方法回顾性分析2015年11月至2017年10月期间于四川省医学科学院·四川省人民医院放射科及四川大学华西医院放射科行CT门静脉血管成像(CTP)检查的119例门静脉高压患者的临床资料,根据发病原因的不同,将119例患者分成肝源性门静脉高压组(HPH组)77例和胰源性门静脉高压组(PPH组)42例。比较2组患者的门静脉系血管管径(包括门静脉干、胃左静脉、脾静脉、肠系膜上静脉和胃网膜静脉),以及不同部位(食管下段静脉、胃底静脉、胃体静脉、Retzius静脉、脐静脉及脾肾分流)静脉曲张的发生率及程度。结果HPH组的门静脉干直径大于PPH组,但胃网膜静脉直径小于PPH组(P<0.05);2组患者的胃左静脉、脾静脉及肠系膜上静脉管径比较差异均无统计学意义(P>0.05)。2组患者的胃底、胃体和食管下段静脉曲张的发生率及曲张程度比较差异均有统计学意义(P<0.05)。HPH组的食管下段静脉曲张发生率及程度较PPH组高(严重),而胃底静脉和胃体静脉曲张发生率较PPH组低。此外,2组患者的脐静脉曲张、Retzius静脉开放以及脾肾分流发生率比较差异也有统计学意义(P<0.05),HPH组的发生率均较高。结论 HPH和PPH患者的侧支循环开放情况存在差异,HPH易同时出现胃底及食管下段静脉曲张,而PPH大多仅发生胃底及胃体静脉曲张,PPH的胃底及食管下段静脉曲张程度均较HPH轻。

Objective The purpose of this study is to compare the differences of opened collateral circulation status between hepatic portal hypertension （HPH） and pancreatogenic portal hypertension （PPH）, to guide the clinical treatment. Methods From Nov. 2015 to Oct. 2017, data of 119 cases of computed tomography portography （CTP） from the Department of Radiology of Sichuan Provincial People＇s Hospital and Department of Radiology of West China Hospital of Sichuan University were retrospective analyzed, and the patients were divided into 2 groups, namely the HPH group （77 patients） and PPH group （42 patients） according to different causes. The diameter of portal vein system （including trunk of portal vein, left gastric vein, splenic vein, superior mesenteric vein, and gastroepiploic vein） and the incidences of varicose veins （lower esophageal vein, gastric fundal vein, gastric body vein, Retzius vein varix, umbilical vein open, and splenorenal shunt）, as well as the degree of varicose of lower esophageal vein, gastric fundal, and gastric body vein were compared. Results The diameter of portal vein in the HPH group was larger than that of the PPH group, but the diameter of gastroepiploic vein was smaller than that of the PPH group, and the differences were statistically significant （P〈0.05）. There was no significant difference in left gastric vein, splenic vein, and superior mesenteric vein between the 2 groups （P〉0.05）. Significant differences were found in varicose veins incidence of gastric and lower esophageal vein （P〈0.05）, the varicose veins incidence of gastric was lower and varicose veins incidence of lower esophageal vein was higher in the HPH group. Statistically significant differences were also found in the incidence of umbilical vein open, Retzius varicose veins and splenorenal shunt between the 2 groups （P〈0.05）, and the incidences were all higher in the HPH group. Conclusions There are differences in collateral circulation status between the HPH and PPH. Gastric fundal and lower esophageal vein varices are easy to appear simultaneously in HPH, while gastric fundal and body vien varices are mostly only occurred in PPH. Compared with HPH, the degree of gastric fundal and lower esophageal vein varices is more mild in PPH.