经皮脾门静脉核素显像预测肝硬化食管静脉曲张破裂出血的临床研究

为探讨经皮脾门静脉核素显像预测肝硬化食管静脉曲张破裂出血的价值，对40例肝炎后肝硬化和12例非肝病患者（对照组）进行经皮脾门静脉核素显像和胃镜检查。结果显示，根据心-肝曲线特点将肝硬化分为门静脉高压无分流型（Ⅰ型）、有分流型（Ⅱ型）、有侧支循环型（Ⅲ型）及完全肝外分流型（四型）。肝硬化组门体分流指数（PSSI）为0.541±0.128，显著高于对照组0.192±0.086（P＜0.01）；Ⅲ型和Ⅳ型的PSSI显著高于Ⅰ、Ⅱ型（P＜0.01）；F2、3组与F0、1组、红色征（＋）组与红色征（－）组，以及出血组与非出血组之间PSSI均有显著性差异（P＜0.01），PSSI＞0.62时，食管静脉曲张破裂出血发生率显著增高。提示经皮脾门静脉核素显像可作为预测肝硬化食管静脉曲张破裂出血的重要手段。

Value of per-splenic scinitigraphy predicting esophageal varices bleeding in patients with liver cirrhosis

To evaluate the value of per-splenic scintigraphy for the prediction of esophageal varices（EV）bleeding in patients with liver cirrhosis.The spleno-portal vein shape and portosystemic shunt index（PSSI）were determined through portal circulation imaging by using intrasplenic injection of99mTc-Phytate.Severity of EV was also observed by gastroscopy.Results showed that the liver cirrhosis were separated into four type，namely nonshunt，shunt，with collateral vein and full-extrahepatic shunt type by per-splenic scintigraphy.The PSSI of controls was 0.192±0.086，cirrhosis group was 0.541±0.128（P＜0.01）.There were significant differences between the nonshunt／shunt type and with collateral vein／full-extrahepatic shunt type in PSSI（mean±SD，0.455±0.098，0.643±0.123，P＜0.01）.There existed a significant difference between PSSI and severity of EV（P＜0.01），including red colour sign（Rc）（＋）and Rc（－）（P＜0.01），F0、1 and F2、3（P＜0.01）.The esophageal varices bleeding patients had a significantly higher level in PSSI than the nonbleeding（P＜0.01）.The PSSI＞0.62 may be the warning figures of variceal bleeding.It suggests that the per-splenic scintigraphy be one of efficient and safe method for predicting the hemorrhage from esophageal varices in patients with liver cirrhosis.