肝性脑病与门静脉高压侧枝循环形成的关系——CT门静脉造影的监测价值

The Relationship between the Encephalopathy and Portal Vein-vena Cava Shunt-the Value of Computed Tomography During Arterial Portography

目的 :评价螺旋CT门静脉造影在门体分流性肝性脑病发病风险中的价值。材料和方法 :门体分流性肝性脑病患者 2 9例 ,采用WestHaven标准分级后行平扫及双期增强扫描 ,对腹腔干、门静脉、下腔静脉及其分支进行三维血管重建。结果 :2 9例患者中 ,Ⅰ级以食管静脉和胃周静脉曲张为主 ;Ⅱ级和Ⅲ级 :除Ⅰ级表现外 ,以脐周静脉、腹膜后静脉、食管周围静脉曲张和奇静脉扩大为主 ,部分有门静脉 -肝动脉瘘和门静脉栓子形成 ;Ⅳ级出现左肾静脉扩大和胆囊周围静脉曲张 ,均伴门静脉 -肝动脉瘘形成。结论 :螺旋CT门静脉造影对门体分流性肝性脑病发病风险具有一定预测价值。

Purpose: To evaluate the value of computed tomography during arterial portography in analysis of the episode risk in encephalopathy. Materials and Methods: Twenty-nine patients with Portal-systemic encephalopathy were classified to four grades by West Haven method. All the patients underwent spiral-CT including plan scans, artery phase and portal vein phase enhancement scans. 3D reconstruction of the celiac trunk, portal vein, inferior vena cava and their branches were performed. Results: In twenty-nine patients,esophageal varices and paragastric varices were noted in grade I. In the grade Ⅱand grade Ⅲ, except for the varices of grade I, cirsomphalos, paraesophageal varices, retroperitoneal varices and dilated azygos vein were the main signs, and some patients had portal vein emboli and the fistula of hepatic artery- portal vein. In grade Ⅳ, Dilated left renal vein and paragallbladder varices were emerged, all the patients had fistula of hepatic artery- portal vein. Conclusion: The computed tomography during arterial portography is valuable for evaluating the episode risk in portal-systemic encephalopathy.