肝硬化门静脉高压侧支循环CT血管成像影像表现及预测上消化道出血的价值

Computed tomography portal venography findings of collateral circulation of hepatic cirrhosis and portal hypertension and the value in predicting upper digestive tract hemorrhage

目的研究门静脉高压侧支循环的CT门静脉成像(CTPV)影像表现,探讨其对肝硬化食管及胃底黏膜静脉曲张破裂出血风险的预测价值。方法回顾性分析抚顺市中心医院2015年1月至2020年8月637例肝硬化患者,最后纳入72例作为研究对象,其中男50例、年龄(54.69±8.92)岁,女22例、年龄(62.78±11.12)岁,收集患者胃镜及CTPV等资料。根据胃镜结果,将患者分为自发性食管胃底黏膜静脉曲张破裂出血组和未出血组。采取二元logistic回归方法,分析侧支循环分流静脉支对食管胃底黏膜静脉曲张破裂出血的影响。结果出血组16例,未出血组56例,所有患者均存在不同类型侧支循环分流血管,CTPV显示侧支循环开放162支,其中食管胃底静脉曲张与食管旁及胃周静脉曲张最常见,分别占41.36%(67/162)、26.54%(43/162),其次为脐静脉或附脐静脉及腹壁静脉曲张与胃/脾-肾静脉分流,分别占16.05%(26/162)、12.35%(20/162),最少见的侧支开放类型为腹膜后静脉曲张,仅占3.70%(6/162)。经多因素二元logistic回归分析,食管胃底静脉分流、胃/脾-肾分流与出血呈负相关(均P<0.05),为保护性因素,可以在一定程度上缓解食管胃底黏膜静脉曲张破裂出血。结论CTPV可多角度、多层面显示门静脉高压侧支循环分流血管的类型、分布及曲张程度,食管旁及胃周静脉支及胃/脾-肾静脉分流支对自发性上消化道出血具有一定的预测价值,在临床治疗及预后具有应用价值。

Objective To study the computed tomography portal venography(CTPV)imaging findings of collateral circulation with portal hypertension and to explore the value in predicting the risk of esophageal and gastric variceal bleeding in patients with hepatic cirrhosis.Methods A total of 637 patients with hepatic cirrhosis in Fushun Central Hospital from January 2015 to August 2020 were retrospectively analyzed,and finally 72 cases were included in this study,including 50 males aged(54.69±8.92)years and 22 females aged(62.78±11.12)years.The data of gastroscopy and CTPV were collected.All patients were divided into a bleeding group and a non-bleeding group based on the gastroscopic results.Binary logistic regression method was used to analyze the effect of collateral circulation shunt on esophageal and gastric fundus mucosal variceal bleeding.Results There were 16 cases in the bleeding group and 56 cases in the non-bleeding group.A total of 162 branches of collateral circulation were showed in CTPV,esophageal and gastric fundus varices and periesophageal and perigastric varices were the most common types,accounting for 41.36%(67/162)and 26.54%(43/162),followed by umbilical or adjacent umbilical and abdominal wall varices,accounting for 16.05%(26/162)and 12.35%(20/162),and the most uncommon type was posterior peritoneal varices,accounting for 3.70%(6/162).Multifactor binary logistic regression analysis showed that esophageal and gastric fundus venous shunt and gastric/splenorenal shunt were negatively correlated with bleeding(both P<0.05),which were protective factors and could relieve esophageal and gastric fundus mucosal variceal rupture and bleeding to a certain extent.Conclusions CTPV has the ability to show the type,distribution,and varicose degree of collateral circulation shunt vessels caused by portal hypertension with multi-angle and multi-slice.Para-esophagea and perigastric vein branches and gastric/splenorenal vein shunt branches have certain predictive value for bleeding and have applicable value in clinical treatment and prognosis.