CT门静脉造影对食管胃静脉曲张出血的应用价值

目的 探讨多排螺旋CT门静脉造影(CTPV)对食管胃静脉曲张出血的临床应用价值.方法 选择同时经胃镜及16排螺旋CT门静脉造影证实有食管胃静脉曲张的69例临床确诊为肝硬化患者,观察食管胃静脉曲张破裂出血与胃左静脉开口位置的关系,以及食管静脉曲张程度与门静脉直径的关系.结果 69例肝硬化患者应用CT门静脉造影方法 可清晰显示门静脉侧支循环血管,其中门静脉主干、胃左静脉均全部显示(100%),89.9%显示食管静脉曲张(62/69),72.5%显示胃底静脉曲张(50/69).胃左静脉开口位于门静脉主干共42例.胃左静脉开口位置与食管胃静脉曲张破裂出血之间存在相关性(X2=4.406,P<0.05);食管静脉曲张程度与门静脉直径无明显关系.结论 CT门静脉造影能很好显示门静脉高压侧支循环血管,并可对血管直径进行准确测量;胃左静脉开口在门静脉主干者易发生食管胃静脉曲张破裂出血;联合应用CT门静脉造影和胃镜检查,能对肝硬化食管胃静脉曲张严重程度及其破裂出血的危险性进行预测.

Value of multi-slice spiral CT portal venography in prediction of esophagogastric variceal bleeding

Objective To assess the clinical value of multi-slice spiral CT portal venography in prediction of esophagogastric variceal bleeding. Methods The relation was detected between esophagogastric variceal bleeding and the location of left gastric vein orifice on portal system. Also the correlation was studied between the severity of esophageal varices endoscopically and the diameter of portal vein with multi-slice spiral CT portal venography. Sixty-nine patients with esophagogastric varices confirmed by both endoscopy and 16-detector row CT portal venography due to cirrhosis were enrolled. Results Excellent image quality of portal collateral vessels with CTPV was obtained in all patients. The portal and left gastric veins were visualized both with CTPV 69/69( 100% ). Esophageal and gastric varices were visualized with CTPV 62/69 (89.9% )and 50/69 (72.5% )respectively. The left gastric vein orifice was located on the portal vein in 42 cases. There was correlation between esophagogastric variceal hemorrhage and the location of left gastric vein orifice (X2 = 4. 406, P < 0. 05 ). But no relation was found between the severity of esophageal varices and the diameter of portal vein ( P > 0. 05 ). Conclusion CTPV can not only provide important and accurate information of collateral circulation in patients with portal hypertension, but also measure the diameter of collateral blood vessel. There is a higher probability of esophagogastric variceal bleeding for the patients with left gastric vein orifice on portal vein. The combined approaches of CTPV and endoscopy can not only diagnose the severity of esophagogastric varices, but also predict the risk of esophagogastric variceal bleeding.