门静脉造影+多层螺旋CT用于肝硬化食管胃底静脉曲张破裂出血患者围术期的意义

Application value of perioperative multi-slice spiral CT portal venography in cirrhotic patients with esophagogastric variceal bleeding

目的分析对肝硬化食管胃底静脉曲张破裂出血患者围术期实施多层螺旋CT门静脉造影的应用价值。方法将辽阳市中心医院2015年1月至2018年12月收治的52例肝硬化食管胃底静脉曲张出血患者作为研究对象,均实施经颈内静脉肝内门体分流术联合胃左静脉栓塞术治疗,围术期采用多层螺旋CT门静脉造影技术进行检查与随访,并评价该检查技术的应用价值。结果术前入选患者中胃冠状静脉曲张48例(92.3%),胃短静脉曲张19例(36.5%),食管静脉曲张49例(94.2%),附脐静脉曲张10例(19.2%)。术后患者门静脉压力由治疗前的(35.3±2.2)cmH 2O下降至(26.1±1.9)cmH 2O,差异具有统计学意义(t=9.837,P<0.001);术后6个月、12个月经随访发现38例患者(73.1%)静脉曲张情况消失并恢复血流通畅,静脉曲张改善后复发12例(23.1%),静脉曲张未改善2例(3.8%)。随访发现6例(11.5%)患者在术后12月内发生了再出血,4例(7.69%)患者在术后6个月内出现肝性脑病,3例(5.8%)患者在术后13~23个月发生肝功能衰竭并导致死亡。结论TIPS联合胃左静脉栓塞术中应用多层螺旋CT门静脉造影,在显示静脉曲张情况、准确引导门静脉穿刺、进行曲张静脉栓塞和支架分流治疗、预后判断等方面具有重要的临床应用价值。

Objective To analyze the application value of multi-slice spiral computed tomography(CT)portal venography over perioperative period in cirrhotic patients with esophagogastric variceal bleeding.Methods A total of 52 cirrhotic patients with esophagogastric variceal bleeding admitted to our hospital from January 2015 to December 2018 were enrolled.All of these patients were treated with the combination of transjugular intrahepatic portosystemic shunt(TIPS)and left gastric vein embolization.Multi-slice spiral CT portal venography was used for perioperative follow-up,and its application value was evaluated.Results Before operation,48 patients(92.3%)had gastric coronary varices,19 patients(36.5%)had short gastric varices,49 patients(94.2%)had esophageal varices,and 10 patients(19.2%)had paraumbilical varices.Portal pressure decreased from(35.3±2.2)cmH 2O before treatment to(26.1±1.9)cmH 2O after treatment,with significant difference(t=9.837,P<0.001).The follow-up at 6 months and 12 months after operation,varices disappeared and blood flow resumed in 38 patients(73.1%),varices relapsed after the improvement in 12 patients(23.1%),and varices had no improvement in 2 patients(3.8%).Within 12 months after operation,variceal rebleeding occurred in 6 patients(11.5%).Within 6 months after operation,hepatic encephalopathy was observed in 4 patients(7.69%).During 13-23 months after operation,3 patients(5.8%)died of hepatic failure.Conclusion For patients undergoing TIPS and left gastric vein embolization,multi-slice spiral CT portal venography has high clinical value in varicose veins monitoring,treatment guiding,and prognosis assessment.