门脉高压侧枝循环CT门静脉成像的临床应用价值

Clinical application value of CT portal venography in collateral circulation with portal hypertension

目的评价电子计算机断层扫描门静脉成像(CTPV)显示门静脉高压的价值,并分析门静脉高压造成的不同类型门-体循环交通分流的影像学表现及相关临床应用价值。方法选取抚顺市中心医院159例门静脉高压患者,其中男性110例,女性49例,进行CT门静脉三维成像,从中筛选有意义的分流静脉支共计297例,分析其余分流静脉支对食管黏膜分流静脉支的影响。结果159例患者全部存在门静脉高压所致的不同类型门-体循环交通分流,其中胃静脉组79.5%(236/297)、左肾静脉组7.7%(23/297)、脐静脉再通7.1%(21/297)、门脉海绵样变2.7%(8/297)、肝内分流0.7%(2/297)、腹膜后组2.4%(7/297),多数病例有2种及2种以上交通分流。并通过CT门静脉三维成像,清楚的显示了引流静脉及分流支。结论CT门静脉三维成像可以显示门静脉高压造成的侧枝循环的分型、发生部位、范围和程度,有效地追踪血流异常途径。这对于临床评估消化道出血风险及采取何种治疗方式有重要的指导意义。

Objective To evaluate the value of computed tomography portal venography(CTPV)in displaying portal hypertension,and to analyze the imaging findings and related clinical value of different types of portosystemic shunts caused by portal hypertension.Methods A total of 159 patients with portal hypertension were selected from Fushun Central Hospital,including 110 males and 49 females.CT three-dimensional imaging of portal vein was performed at the same time.A total of 297 cases of meaningful shunt branches were selected,and the effects of other shunt branches on esophageal mucosal shunt branches were analyzed.Results All 159 patients had different types of portosystemic communication shunts caused by portal hypertension,including gastric vein group 79.5%(236/297),left renal vein group 7.7%(23/297),umbilical vein recanalization 7.1%(21/297),portal cavernous transformation 2.7%(8/297),intrahepatic shunt 0.7%(2/297)and retroperitoneal group 2.4%(7/297).In most cases,there were two or more types of communicating shunt,the draining vein and shunt branches were clearly dis-played by a three-dimensional imaging of CT portal vein.Conclusions Three-dimensional CT portal vein imaging can show the classification,location,extent and degree of collateral circulation caused by portal hypertension,and effectively track the path of abnormal blood flow,which has important guiding significance for clinical evaluation of the risk of gastrointestinal bleeding and treatment.