肝硬化门静脉高压侧枝血管的多层螺旋CT表现

目的用多层螺旋CT(MSCT)统计、分析肝硬化门静脉高压患者的侧枝循环表现。方法收集203例肝硬化门静脉高压患者MSCT上腹部检查的完整资料。结果共发现门静脉侧枝或异常血管612处:食管下段静脉曲张175处,食管旁静脉曲张49处(其中伴假肿瘤征13处),胃底静脉曲张119处,胃冠状静脉曲张105处,胃肾静脉分流34处,脾肾静脉分流15处,椎旁静脉丛曲张16处,脐静脉再通48处,副脐静脉再通22处,脐静脉、副脐静脉同时再通4处,腹壁静脉丛曲张呈蛇头征12处,门静脉海绵样变8处,门静脉右后支瘤样扩张并与下腔静脉分流4处,胃左静脉直接入肝与门静脉左支相连1处。结论MSCT可较好地显示各类门静脉高压侧枝,了解这些异常表现有助于作出正确诊断,避免误诊,对临床选择治疗方法有重要的意义。

Multislice Spiral CT Manifestations of Collateral Vessels in Patients with Liver Cirrhosis and Portal Hypertension

Objective To state and analyze collateral vessels in patients with cirrhosis and portal hypertension with multislice spiral CT (MSCT).Methods 203 cases of cirrhosis and portal hypertension were included in the study and undergone upper abdomen examination with MSCT.Results 612 collateral vessels were demonstrated in this group: lower esophageal varices in 175, paraesophageal varices in 49, including greatly dilated azygos or hemiazygos veins and showing mediastinal pseudotumors in 13, gastric fundic varices in 119, left gastricvarices in 105, gastrorenal shunts in 34, splenorenal shunts in 15, paravertebral varices in 16, reopened umbilical vein in 48, reopenedparaumbilical vein in 22, reopened umbilical vein and paraumbilical vein in 4, abdominal wall varices and caput medusa sigh in 12, portalvein cavernous transformation in 8, greatly dilated right posterior portal vein connecting the inferior vena cava in 4 and left gastric veindirectly connected with the left portal branch in 1. Conclusion MSCT can much more clearly demonstrate the collateral vessels in patients with cirrhosis and portal hypertension. An understanding of the varied appearances of acquired abnormalities of the portal venous system will allow more definitive diagnosis and help avoid false diagnosis of disease, and may play a significant role in making a clinical treatment plan.