多层螺旋CT门静脉血管成像与内镜对食管、胃静脉曲张诊断的比较研究

目的对比研究多层螺旋CT门静脉血管成像(CTP)和内镜对食管、胃静脉曲张的诊断。方法采用16排多层螺旋CT门静脉血管成像,对57例临床和实验室检查提示门静脉高压的患者进行CTP,观察门静脉及其分支走形、分布,并结合横断面图像仔细观察食管和胃有无静脉曲张,并记录其部位、曲张静脉深浅、观察曲张静脉来源、有无其他部位曲张静脉或其他病理情况。同期对这些病例行胃镜检查,观察食管、胃是否存在静脉曲张及其他病变。结果CTP显示食管及胃静脉曲张病例51例,其中胃底静脉曲张合并食管静脉曲张39例,单纯胃底静脉曲张9例,胃底静脉曲张合并胃体静脉曲张3例。内镜发现食管及胃底静脉曲张46例,其中胃静脉曲张合并食管静脉曲张24例,单纯胃静脉曲张5例,单纯食管静脉曲张17例。CTP可发现内镜无法诊断的肌层或管腔外静脉曲张。结论CTP可清晰显示门静脉高压患者食管、胃底静脉曲张及主要侧支血管的走行、分布。在食管静脉曲张检查方面,CTP与内镜效果相当,CTP有几例假阳性,可作为普通内镜检查的良好补充;对于胃静脉曲张的检查,CTP效果较胃镜敏感,且CTP可清晰显示内镜无法观察的胃腔周围和食管周围静脉曲张。

A comparative study on the diagnosis of esophageal and gastric varices between multislice spiral CT portography and endoscopy

Objectives To investigate the diagnosis of esophageal and gastric varices between multi-slice spiral (MS) CT portography and endoscopy. Methods Fifty-seven patients clinically diagnosed with portal hypertension were underwent MSCT portography by LightSpeed 16 CT scanner. The endoscopic examinations were also carried out in those patients within 3 days. Results The CT portography revealed that 51 patients with esophageal or gastric varices, including 39 patients with both gastric fundal varices and esophagus varix, 9 patients with only esophagea! varices, 3 patients with gastric body and gastric fundal varices. While 46 patients were found by endoscopy to have esophageal or gastric varices, including 24 patients with both esophageal and gastric varices, 5 patients with only gastric varices and 17 patients with only esophageal varices. Conclusions The MSCT portography can clearly demonstrate the esophageal and gastric fundal varices, as well as major collateral vessels in portal hypertension patients. There is certain false positive in MSCT portography, and they can be used as supplement tests to endoscopy in the diagnosis of esophageal varices. The MSCT portography is more sensitive than endoscopy in diagnosis of gastric varices, and can visualize the para esophageal and para-gastric varices that are not visible to the endoscopy.