多层螺旋CT血管成像诊断胰源性与肝硬化门脉高压不同侧支循环的价值

目的探讨多层螺旋CT血管成像(MSCTA)评价肝硬化性及胰源性门脉高压不同侧支循环开放的价值.方法胰源性和肝硬化所引起的门脉高压患者各19例,均进行MSCT检查,并经后处理重建显示二者侧支循环.结果胰源性门脉高压常引起胃网膜右静脉(18/19)和胃冠状静脉曲张(15/19),较少有食管下段静脉曲张(2/19),无脐静脉开放;而肝硬化门脉高压较常见胃冠状静脉(19/19)、食管下段静脉曲张(15/19)和脐静脉开放(9/19),无胃网膜右静脉曲张.结论 MSCTA在诊断及鉴别诊断胰源性和肝硬化所引起的门脉高压不同侧支循环具有重要临床价值.     

多排螺旋CT血管成像技术对肝硬化门脉高压侧支循环血管的显示价值

目的探讨多排螺旋CT(MDCT)显示肝硬化门脉高压症侧支循环血管的诊断价值. 方法对肝硬化门脉高压患者23例,使用16排螺旋CT机行上腹部增强CT扫描,采用MPR、MIP、VRT等三维重建技术进行图像后处理,获得门静脉系统血管图像以显示开放的侧支循环血管. 结果显示食管胃底黏膜下静脉曲张20例,食管旁静脉曲张7例;胃左静脉曲张18 例,胃短静脉曲张16例;奇静脉、半奇静脉曲张8例;脐旁静脉与腹壁静脉曲张9例;脾肾、胃肾之间分流7例;腹膜后分流11例.结论 MDCT门静脉系统血管成像技术能良好地显示肝硬化门脉高压侧支循环血管,具有重要临床应用价值.     

胰源性区域性门脉高压CT成像的临床应用价值

目的探讨胰源性区域性门静脉高压的CT门静脉成像的临床应用价值。方法前瞻性选择70例胃镜提示胃底静脉曲张的患者,进行CT增强扫描及后处理,分析其中28例胰源性门静脉高压患者的CT表现。结果在28例胰源性门静脉高压患者中,显示GEV扩张24例,CGV扩张21例,SGV扩张23例,发生胃肾分流4例,图像重建后可以清楚显示各血管的走行及曲张程度。结论CT门静脉成像可以连续的显示血管走行及其毗邻关系,多角度显示侧支循环血管,有助于指导术前分析和评估,对胰源性区域性门静脉高压具有重要临床诊断价值。     

64层螺旋CT门静脉造影对门静脉高压侧支循环的研究

目的 评价64层螺旋CT门静脉造影对门静脉高压侧支循环的诊断价值.方法 正常者30例、肝硬化患者27例,行64层螺旋CT门静脉造影检查,容积数据采用最大强度投影法(MIP)、容积再现法(VR)及多平面重组法(MPR)三维重建,观察门静脉高压肝内门静脉、属支及侧支循环的影像学特征.结果 64层螺旋CT 门静脉造影能准确显示侧支循环分布范围、初步评估病变程度;门静脉高压症组门静脉属支管径显著大于正常组(P=0.000);肝功能对于其管径改变无显著影响(P值分别为0.343,0.778、0.367、0.370);脾/胃肾静脉分流的存在对门静脉直径有影响(P=0.000);脾静脉与胃左静脉共同分担门静脉压力及参与胃脾区高压形成,两者直径呈正相关性(r=0.653,P=0.000);64层螺旋CT诊断食管胃底静脉曲张与胃镜诊断有高度一致性(Kappa值为0.832).结论 64层螺旋CT门静脉造影能够多角度、立体观察侧支循环情况,对预测其并发症、于术方案的制定具有重要的指导意义.     

胰源性区域性门静脉高压症的螺旋CT 诊断 ———与门静脉高压的对照研究

目的　探讨胰源性区域性门静脉高压 (PSPH)的CT表现及其鉴别诊断。方法　回顾性分析 1 8例PSPH的螺旋CT表现 ,并以 30例肝炎后门静脉高压 (PH)作为对照 ,着重观察胃周侧支静脉开放情况。结果　在PSPH和PH中 ,食管下端静脉、胃冠状静脉、胃短静脉、胃网膜静脉曲张或扩大的比例分别为 1 1 %、72 %、94%、94%和 1 0 0 %、1 0 0 %、2 8%、2 0 %。结论　与PH相比 ,PSPH的胃周侧支循环开放具有特征性 ,这对于PSPH的诊断和临床治疗具有指导意义     

CT门静脉血管成像与内镜诊断胃食管静脉曲张的比较

目的比较CT门静脉血管成像(CTP)与内镜诊断肝硬化胃食管静脉曲张的效果,探讨CTP对肝硬化门静脉高压侧支循环血管的显示及其在随访中的价值。方法对2010年1月-2011年12月收治的43例肝硬化患者行多排螺旋CT增强扫描门静脉血管成像,观察胃食管静脉曲张程度,及有无其他侧支开放,并在4周内行内镜检查,了解胃食管静脉曲张的程度。结果 43例患者中有33例经胃镜确诊食管静脉曲张,其中CTP诊断与胃镜相符29例;胃镜诊断胃底静脉曲张14例,其中有12例CTP诊断与之相符;CTP诊断胃食管静脉曲张与内镜有较好的相关性和一致性,但在判断食管静脉曲张部位上与胃镜一致性较差。结论对肝硬化患者可采用CTP进行随访,以评估胃食管静脉曲张出血风险,可减少不必要的内镜随访。     

多层螺旋CT门静脉造影诊断肝硬化门静脉高压

目的评价门静脉CT血管造影对肝硬化门脉高压患者的诊断价值.方法对43例经临床、肝功能和影像学检查诊断的肝硬化门脉高压患者进行门静脉CT血管成像(CTPV),对门静脉主干、主要属支和侧支循环血管进行显示和测量.结果 43例患者均成功地实施了门静脉CTPV,门静脉主干显示率100%,胃左静脉97.6%,胃短静脉44.2%,食管胃底静脉曲张90.7%,脾/胃肾分流28.7%,脐静脉、腹壁静脉曲张分别为46.5%、44.4%.其中门静脉主干宽度为(13.94±2.47) mm,胃左静脉主干宽度为(5.62±2.40) mm.结论 CTPV可显示肝硬化门脉高压患者的门-体静脉之间侧支循环血管,有助于对门脉高压合并消化道出血患者选择合理治疗方案及进行疗效随访.     

胰源性区域性门静脉高压症的彩超诊断

目的 探讨胰源性区域性门静脉高压症（PSPH）的彩色多普勒超声诊断（CDUS）和鉴别诊断。方法 回顾性分析胰源性区域性门静脉高压症（PSPH）的彩超表现并与肝硬化性门静脉高压症（CPH）进行对照分析，重点观察胃周静脉（含GCV，GEV、GSV）彩超表现，侧支循环表现。结果 PSPH10例中，胃冠状静脉（GCV）、胃网膜静脉（GEV）、胃短静脉（GSV）曲张显示率分别为：70％、100％、100％，其内径分别为≥5mm，≥5mm，≥4mm。1例显示脾肾侧支血管。CPH20例中，GCV100％显示，GSV30％显示，GEV20％显示。2例显示食道下端静脉曲张；14例显示侧支循环血管开放，以脾肾静脉侧支为多。结论 肝脏回声正常，门静脉主干不增粗，胰腺占位病变，脾静脉阻塞、脾肿大，胃周静脉曲张是PGPH的诊断依据。弥漫性肝病变图像，门静脉主干增粗，肝被膜回声改变2级以上，脾肿大及胃周静脉曲张及脐静脉开放等侧支血管显示是CPH的诊断依据。彩超能正确区分PSPH与CPH，能为临床制订治疗方案提供有价值的诊断信息。     

胰源性区域性门静脉高压的螺旋CT表现及临床意义

胰腺肿瘤或炎性病变易侵犯或压迫脾静脉而致其阻塞,造成其引流区域血管系统形态和功能上的改变,称为胰源性区域性门静脉高压症(PSPH).①胃短静脉→胃底静脉丛→胃冠状静脉和②胃网膜静脉→胃结肠干→肠系膜上静脉是PSPH主要的两个侧支循环通道,在螺旋CT上表现出特征性的分布和走行,并在胰腺癌术前分期和评估PSPH方面具有重要临床意义.增强多排螺旋CT血管成像技术有利于连续追踪上述血管走行, 清晰显示其毗邻关系,有助于PSPH的诊断.     

胰源性门静脉高压症2例临床分析并文献复习

目的:探讨胰源性门静脉高压症的临床特点及诊治方法.方法:对经手术确诊的2例胰源性门静脉高压症患者的临床资料进行数理分析.结果与结论:2例患者均以上消化道出血为表现入院,均有胰腺病变、孤立性胃底静脉曲张、脾大,肝功能正常,无肝硬化等临床特点.1例诊断为胰源性门静脉高压症、慢性胰腺炎;另1例诊断为结肠克罗恩病并胃瘘、胰尾粘连、胰源性门静脉高压症.分别行巨脾切除、胰尾切除、贲门周围血管离断术及结肠脾曲切除术、胃部分切除术、瘘管切除手术,手术治疗后恢复良好.     

Cavernous transformation of the portal vein secondary to tumor thrombosis of hepatocellular carcinoma: spiral CT visualization of the collateral vessels

Background: We investigated the constituting collateral vessels in cavernous transformation of the portal vein (CTPV) caused by tumor thrombosis of hepatocellular carcinoma (HCC) by using contrast-enhanced spiral computed tomographic (CT) examination. Methods: Fifty-four histopathologically proven HCC patients with tumor thrombosis-induced CTPV were retrospectively included and assigned to cirrhosis negative (n= 31) and positive (n= 23) groups. Another 15 cirrhotic patients with portal hypertension but no HCC and CTPV were used for comparison. Standardized dual-phase contrast-enhanced spiral CT was performed for all patients. CT appearances of the collateral vessels of CTPV were observed, and their visualization rates were analyzed. Results: Biliary (cystic and paracholedochal veins) and gastric (left and right gastric veins) branches of the portal vein were the most frequently visualized collateral vessels of CTPV. There was a marked difference in CT visualization rates for biliary branches between patients with and without CTPV (83–94% vs. 0). No difference existed in visualization rates for gastric branches across the three groups (77–87% for left gastric, 58–61% for right gastric vein). Conclusions: Biliary and gastric branches of the portal vein are the major collateral vessels of CTPV. The intergroup differences in CT visualization rates may provide clues to the roles that they might play in the hemodynamic adaptation process of CTPV. Received: 13 October 1999/Accepted: 12 January 2000     

Xper-CT与CTPV融合图像在经颈静脉肝内门腔静脉内分流术中的应用

目的 评价利用Xper-CT与CT门静脉造影（CTPV）融合图像作为经颈静脉肝内门腔静脉内分流术（TIPS）中三维路径图的可行性。方法 收集门静脉高压症患者37例,其中21例接受常规TIPS术患者,另16例接受3D路径图下引导TIPS,采集动静脉期和门静脉期图像,对3D路径图下引导TIPS患者在肝脏部位行Xper-CT扫描,在三维工作站中利用"Multi-Modality Matching"功能进行两者图像融合,作为实时透视过程中的三维路径图。结果 Xper-CT与CTPV在融合过程中,骨性对位误差均<2.00 mm;术中门静脉CTPV图像与透视的图像的匹配误差稍大,其中15例上下误差>2.00 mm,1例左右误差>5.00 mm。结论 将Xper-CT与CTPV的融合图像作为TIPS的三维路径图,可在不使用对比剂的情况下,术中多角度观察穿刺针与门静脉的位置关系,提高穿刺的定位准确性和安全性,减少手术时间。     

64层螺旋CT门静脉成像诊断门静脉海绵样变性

目的 探讨64层螺旋CT门静脉成像在门静脉海绵样变性(CTPV)诊断中的价值. 方法 收集并分析42例经证实的CTPV患者的64层螺旋CT门静脉成像资料. 结果 全部病例门静脉主干和(或)其分支闭塞和(或)狭窄.本组门静脉异常表现为门静脉主干和(或)其分支因栓子闭塞和(或)狭窄34例;门静脉受侵闭塞和(或)狭窄5例;门静脉原因不明的狭窄或闭锁3例.门静脉周围形成增粗、扭曲的侧支血管即门-门侧支血管:胆管周围静脉丛曲张39例;胆囊静脉丛曲张31例,有分支向肝内门静脉左支供血的胃左静脉曲张6例;并清楚显示多种门-体侧支血管;肝脏灌注异常18例;胆囊、胆管壁增厚28例. 结论 64层螺旋CT门静脉成像能很好地显示CTPV的特征,是很有效的诊断方法 .     

肝门静脉海绵样变性的CT特点

目的 分析门静脉海绵样变性(CTPV)的肝脏动脉及肝脏形态学变化的影像学特点.方法 13例CTPV患者,排除肝脏恶性肿瘤及肝硬化、肝脓肿等可引起肝脏动脉改变的疾病,分析其CT资料,观察肝脏动脉及肝脏形态的改变.结果 13例CTPV患者中,10例(76.92%)可见肝左和(或)肝右动脉增粗,3例(23.08%)可见动脉期的一过性团片状异常强化,仅1例(7.69%)可见明显的萎缩-增生复合体.结论 CTPV肝脏动脉供血增加,可出现肝脏动脉增粗,仅少数可见明显的萎缩-增生复合体.     

Combined Rex-bypass shunt with pericardial devascularization alleviated prehepatic portal hypertension caused by cavernomatous transformation of portal vein

Objective: To evaluate the effects of combined Rex-bypass shunt and pericardial devascularization on prehepatic portal hypertension secondary to cavernomatous transformation of portal vein (CTPV).

Methods: Forty-two patients aged from 3 years to 49 years (divided into 3 groups), 26 cases male and 16 female, with prehepatic vascular hepertention were treated with Rex-bypass shunt combined with pericardial devascularization. In each patient, preoperative assessment included ultrasound and computed tomographic angiography of the portal vein and blood analysis. The procedure was Rex-bypass shunt (with or without graft), and patients with moderate or severe gastroesophageal varices required additional paraesophagogastric devascularization. Splenectomy or subtotal splenectomy was performed if combined hypersplenism co-existed. All data were analyzed retrospectively.

Results: No intraoperative death occurred, blood routine analysis improved (P < 0.05), the blood flow velocity (P < 0.05) and diameter (P < 0.05) of the left portal vein (LPV) significantly increased, the esophageal and gastric varices significantly relieved in 34 patients (P < 0.05), and better effects of earlier operations were demonstrated than the delayed ones (P < 0.05). During the period of follow-up from 6 to 64 months, the overall patency rate was 85.7% and the younger the age the better of the effect.

Conclusion: Rex-bypass shunt combined with pericardial devascularization is a safe and effective procedure for prehepatic portal hypertension caused by CTPV.     

自身免疫性胰腺炎的CT诊断

目的 探讨自身免疫性胰腺炎(ALP)的CT表现.方法 回顾性分析6例AIP患者的临床资料,5例行螺旋CT平扫 增强扫描,其中3例患者行CT延迟扫描,其中的1例患者与另1例患者行PET/CT检查;从胰腺形态、大小、强化形式、胰管、胆总管、胰周及腹膜后间隙分析CT表现.结果 66.7%(4/6例)AIP表现为胰腺弥漫增大,33.3%(2/6例)表现为胰腺局限性增大;66.7%(4/6例)可见"鞘膜"征;100%(5/5例)增强扫描呈门脉期和延迟期均匀强化;100%(6/6例)有主胰管狭窄;33.3%(2/6例)可见胆总管胰头段狭窄致低位胆道梗阻;33.3%(2/6例)伴淋巴结肿大.2例(100%)PET/CT提示病变摄取增高.结论 自身免疫性胰腺炎具有典型的CT表现,能够明确诊断,避免不必要的手术.动脉期、门脉期及延迟期增强CT扫描对其诊断具有重要价值.     

Vascular and biliary abnormalities mimicking cholangiocarcinoma in patients with cavernous transformation of the portal vein: role of color Doppler sonography.

OBJECTIVE: The purpose of this study was to describe and evaluate the sonographic and color Doppler features of tumorlike biliary and venous changes in patients with cavernous transformation of the portal vein (CTPV). METHODS: The sonographic studies of 24 patients with CTPV were reviewed. Sonographic evaluation of the biliary system included measurement of intrahepatic and extrahepatic biliary duct caliber changes and common bile duct (CBD) wall thickening and character. Color Doppler features of the portoportal collateral circulation at various locations (intrahepatic, periportal, gallbladder, pancreatic, and gastric regions) were carefully evaluated. RESULTS: Biliary abnormalities were detected in 13 (54%) of 24 patients with CTPV. All 13 patients (100%) had intrahepatic biliary dilatation; 11 patients (85%) had CBD abnormalities: diffuse CBD wall thickening causing diffuse narrowing of the true lumen in 7 (54%) and CBD dilatation proximal to the focal area of narrowing due to pericholedochal compressing venous collaterals in 4 (30%). A tumorlike solid mass appeared on the gray scale images of 2 patients (8%): 1 at the porta hepatis and the other at the pancreatic head level. Color Doppler imaging evaluation showed venous-type flow, suggesting a bulk of varicosities. CONCLUSIONS: Portoportal collaterals in patients with CTPV may alter the biliary and venous systems, causing biliary wall thickening, stenosis, intrahepatic and extrahepatic dilatation, and pseudotumors. Detailed sonographic and color Doppler imaging assessment can show and facilitate the correct diagnosis of those changes, thus avoiding the need for a more invasive modality such as endoscopic retrograde cholangiopancreatography or a more expensive investigation such as magnetic resonance cholangiopancreatography.     

Usefulness of cone-beam computed tomography during balloon-occluded retrograde transvenous obliteration

Abstract

Objective: The purpose of our investigation was to evaluate the usefulness of cone-beam computed tomography (CBCT) in balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices. Material and methods: Between December 2010 and March 2011, four patients underwent B-RTO for gastric varices that occurred after portal hypertension. In all, after insertion of sclerotic agents, CBCT was used to observe distribution of the sclerotic agent in the gastric varices and afferent gastric veins. Investigated was whether the entire gastric varices and afferent gastric veins were confirmed by retrograde venography performed when the sclerotic agent was infused and by CBCT obtained after insertion of the sclerotic agent. Results: On CBCT obtained after insertion of the sclerotic agent, distribution of sclerotic agents in the gastric varices and afferent gastric veins was clearly visualized. On the other hand, retrograde venography was inferior in detecting the area of distribution of sclerotic agents and the afferent gastric veins. Conclusion: Application of CBCT is helpful to precisely evaluate the distribution of sclerotic agents in B-RTO.     

门静脉高压并异位静脉曲张的流行病学及内镜治疗现状*

门静脉高压(PH)为各种病因引起的门静脉压力升高。门-体侧支循环形成是PH一种代偿形式。消化道内静脉曲张是PH的临床表现之一,并可大致分为食管静脉曲张(EV)、胃静脉曲张(GV)、异位静脉曲张(Ec V)。目前关于Ec V的研究非常有限。目前发现Ec V诊断困难、出血量大、止血困难和预后差等特点。Ec V治疗也尚无指南和专家共识。该综述将重点对Ec V的流行病学特点和内镜治疗现状进行综述。