肝硬化门静脉高压侧支血管开放的影像学特征及临床意义

目的探讨肝硬化引起的门静脉高压侧枝血管开放的影像学特征及临床意义。方法收集从2013年2月至2015年9月于我院住院的肝硬化病人92例,包括病人肝性脑病、腹水的临床资料及白蛋白、凝血酶原时间等实验室指标,并进行肝功能Child分级;所有患者均行CT门静脉成像检查,并在工作站进行最大密度投影等图像后处理,分析各侧枝循环之间的相互关系及侧支循环与肝功能Child分级、临床表现、实验室检查之间的关系。结果CT门静脉成像可以清楚显示各侧枝循环的起止、走行及形态特点;食管静脉、食管旁静脉、附脐静脉三者随肝功能严重程度增高出现率上升(P0.05);胃左静脉宽度的增大可以导致更多侧枝血管开放(P0.05);食管旁静脉可以降低食管静脉曲张但不能减少胃底静脉曲张;食管静脉、食管旁静脉、胃底静脉、附脐静脉的曲张可提高腹水的发生率(P0.05);不同侧枝血管开放支数的实验室指标如白蛋白、凝血酶原时间等差别不具有统计学意义(P0.05)。结论 CT门静脉成像对于观察各种侧枝循环的起止、走行及形态特点具有巨大优势,可以为临床诊治评估提供客观依据,了解不同侧枝循环相互间关系及其与临床表现的关系对病情评估和预后判断具有重要价值。

The Clinical Significance and Imaging Features of Collateral Vessels in the Portal Hypertension of Hepatic Cirrhosis

Objective To explore the clinical significance and imaging features of collateral vessels in the portal hypertension of hepatic cirrhosis.Methods 92 hospitalized cases of hepatic cirrhosis from February, 2013 to September, 2015 were collected, including the clinical data of hepatic encephalopathy, ascites and albumin, prothrombin time, etc. All the cases were classified into three groups according to Child-Pugh classification standard and they were all examined CT portal venography. All the images were given image postprocessing such like VR (Volume Rendering), MIP(Maximun Intensity Projection), et al. The data of different collateral vessels were used to analyzed the relationship of themselves and their connection with the clinical manifestations and laboratory tests.Results CT portal venography can show the beginning and end, route and forms of different collateral varices clearly. The occurance rate of esophageal vein, Paraesophageal vessels, paraumbilical vein increased by the worse liver function(P<0.05). The width enlargement of left gastric vein lead to more collateral varices(P<0.05);Paraesophageal vessels can reduce the occurance of esophageal varices(P<0.05) rather than gastric varices(P>0.05); The occurance rate of ascites increased while there were esophageal, Paraesophageal, gastric or paraumbilical varices(P<0.05). The difference between the laboratory tests such as albumin, prothrombin time, total bilirubin and the amount of collateral vessels was not statistically significant(P>0.05).Conclusion CT portal venography is a dominant technique to show the beginning and end, route and forms of different collateral circulation which can provide objective base to clinical diagnosis and treatment. It is important to understand the relationship between each other and their relationship with clinical manifestation for the disease assessment and prognostic judgement.