门-体分流程度评估血吸虫病肝硬化上消化道出血的应用

目的探讨门-体静脉分流程度在评估血吸虫病肝硬化上消化道出血中的应用。方法以金山医院经临床证实的33例血吸虫病肝硬化上消化道出血患者,及29例血吸虫病肝硬化非出血患者为研究对象,对其进行上腹部128层螺旋CT扫描。采用薄层块最大强度投影(TSMIP)、多平面重建(MPR)对门静脉系进行血管重建,对两组患者门-体静脉分流程度进行评分和比较,分析各侧支血管分流程度与血吸虫病肝硬化上消化道出血的关系。结果 33例上消化道出血患者中,侧支血管发生率如下:胃左静脉曲张86.4%、胃短静脉曲张68.2%、食管静脉曲张50.0%、食管旁静脉曲张50.0%、胃底静脉曲张37.9%、胃肾静脉69.7%、脾肾静脉51.5%、腹壁静脉曲张25.8%、网膜静脉曲张15.2%、脾周静脉曲张63.6%、附脐静脉曲张34.8%、腹膜后-椎旁静脉40.9%、肠系膜静脉曲张36.4%。出血组食管静脉、食管旁静脉、胃左静脉和胃底静脉的发生率和分流程度均明显大于非出血组(P值均0.05)。结论 CT门静脉系成像可精确显示各类侧支血管的部位、程度及走向。食管静脉、食管旁静脉、胃左静脉和胃底静脉能较准确地预测血吸虫病肝硬化上消化道出血的风险情况,上述侧支血管分流程度越高,上消化道出血危险性就越大。

Application of degree of portal systemic shunting in assessing upper gastrointestinal bleeding in patients with schistosomiasis cirrhosis

Objective To discuss the application of the degree of portal systemic shunting in assessing the upper gastrointestinal bleeding in patients with hepatic schistosomiasis. Methods Thirty?three patients with upper gastrointestinal bleeding caused by hepatic schistosomiasis （a bleeding group） and 29 schistosomiasis cirrhosis patients without bleeding （a non?bleeding group） were enrolled as investigation subjects in Jinshan Hospital. The subjects were scanned by the 128 abdominal slice spiral CT. The portal systemic shunting vessels were reconstructed by using thin slab maximum intensity projection （TSMIP） and multi?planar reconstruction （MPR）. The degrees of the shunting vessels of the subjects were evaluated and compared， and the relationship between upper gastrointestinal bleeding and the degree of the shunting was analyzed. Results In the bleeding group， the occurrence rates of the shunting vessels were found as follows： 86.4% in left gastric varices， 68.2% in short gastric varices， 50.0% in esophageal varices， 50.0% in para?esophageal varices， 37.9% in gastric varices， 69.7% in gastric?renal varices， 51.5% in spleen?renal varices， 25.8% in abdominal wall varices， 15.2% in omentum varices， 63.6% in para?splenic varices， 34.8% in umbilical varices， 40.9% in retroperitoneal?paravertebral varices， and 36.4% in mesenteric varices. In the bleeding group， the occurrence rates and the degree of shunt were significantly higher than those in the non?bleeding group in esophageal varices， esophageal vein， left gastric vein and gastric varices （all P < 0.05）. Conclusions CT portal vein reconstruction can accurately display the location， degree and walking of all kinds of shunting vessels. Esophageal varices， esophageal vein， left gastric vein and gastric varices can accurately predict the risk of upper gastrointestinal bleeding in patients with hepatic schistosomiasis. The patents with higher degree of the shunting vessels have a higher risk of gastrointestinal bleeding.