区域性门脉高压胃底静脉曲张的影像诊断与介入治疗

Imaging diagnosis and interventional therapy of gastroesophageal varices in regional portal hypertension

目的探讨区域性门脉高压胃底静脉曲张的影像诊断及介入治疗的临床疗效。方法将我院2015年9月至2016年8月收治的43例区域性门脉高压胃底静脉曲张患者纳入本次研究,对本组患者实施术前多层螺旋CT增强扫描,观察患者的CT表现,判断患者急性上消化道出血的原因和治疗方案。本组患者均行经皮肝门静脉造影和逆行性左肾静脉分流道造影,并行逆行性胃底静脉栓塞和硬化治疗;术后1个月,增强CT复查腹部,观察与对比术前、术后胃底静脉曲张情况。总结患者CT的影像学特点及DSA特点,并分析介入治疗的疗效、该组患者影像学诊断结果与术中造影结果的符合率,以及术后胃底静脉曲张的情况。结果本组患者均获得高质量的影像学资料,其中41例经CT诊断发现无明显的肝硬化,仅有脾大表现,门静脉主干不大,无腹水,仅表现为胃底静脉曲张,可见胃—肾分流或脾—胃—肾分流,CT诊断结果与DSA造影符合率为95.35%。胃底静脉影像学表现分迂曲型和结节型,大多突入胃腔,临床上主要表现为急性上消化道出血。多层螺旋CT静脉成像可见胃底静脉为黏膜下团状迂曲扩张的血管。本组患者的手术成功率为100.00%,无术中、术后并发症,术后无复发性上消化道出血。患者术后复查CT,粗大的胃底静脉萎缩消失40例,仅有少量曲张静脉3例,复查大便潜血均为阴性,治疗总有效率为100.00%。结论 CT诊断区域性门脉高压胃底静脉曲张,准确性高。对区域性门脉高压胃底静脉曲张患者实施介入治疗,创伤性小,术后并发症少,疗效可靠。

Objective To study the imaging diagnosis and interventional therapy effect of gastroesophageal varices in regional portal hypertension.Methods From September 2015 to August 2016,43 cases of gastroesophageal varices in regional portal hypertension were enrolled in this study,and they received preoperative multislice CT enhanced scan,the patients'CT performances were observed,the reasons and treatment solution of acute upper gastrointestinal bleeding were determined.The patients received hepatic portal vein angiography and retrograde left renal vein shunt imaging,with retrograde gastric venous thrombosis and hardening treatment;1 month after operation,abdomen enhanced CT was reviewed,the preoperative and postoperative gastric varices were observed and compared.The CT imaging features and DSA features were summarized,then the interventional therapy effect,coincidence rate of imaging diagnosis and intraoperative angiography,and postoperative gastric varices were observed.Results The patients all obtained high quality imaging data,among them,41 cases were diagnosed with no obvious cirrhosis by CT,only had splenomegaly,portal venous trunk was not big,no ascites,only showed the gastric varices,and with stomach-renal shunt or spleen-stomach-renal shunt,and the coincidence rate of CT and DSA imaging was 95.35%.Gastroscopic venography showed tortuosity and nodular type,mostly into the gastric cavity,the main clinical manifestations was acute upper gastrointestinal bleeding.Multi-slice spiral CT venography showed the gastric fundus submucosal tortuous dilatation of blood vessels.The success rate of operation was 100.00%,without intraoperative and postoperative complications,as well as the postoperative recurrence of upper gastrointestinal bleeding.The postoperative CT results showed massive gastric venous atrophy disappearing in 40 cases,only a small amount of varicose vein in 3 cases and defecate occult blood were negative,and the total treatment effective rate was 100.00%.Conclusion The accuracy rate of CT was high in the diagnosis of regional portal hypertension gastric varices.For patients with regional portal hypertension gastric varices,intervention treatment has advantages of small traumatic and less postoperative complications,the curative effect was reliable.