MSCT门静脉解剖分型与肝炎后肝硬化相关性研究

目的研究门静脉解剖分型及腹水、肝性脑病、Child-Pugh分级等肝硬化并发症与侧枝血管开放数量的关系。方法选取肝炎性肝硬化95例,行门静脉系统主要属支及侧枝血管MIP、MPR及VR重建,测量各血管直径并观察侧枝循环开放的情况。依据Child-Pugh分级及腹水严重程度,将95例患者分别分为Child-Pugh A、B和C级三组及无腹水、轻度腹水、中-重度腹水三组。对门静脉属支解剖变异进行统计分型,并将结果与侧枝血管、肝硬化临床指标进行统计学分析。结果肝硬化6种类型间比较,侧枝血管开放的数量差异无统计学意义(P0.05)。肝硬化ChildPugh A、B、C三级间比较,侧枝血管开放数量的差异均有统计学意义(P0.05);肝硬化无腹水、轻度、中-重度腹水三组间比较,侧枝血管开放的数量在无腹水组与中-重度腹水组间,差异有统计学意义(P0.05),其余无统计学意义(P0.05)。结论 MSCT门静脉成像及图像后处理技术对门静脉解剖变异的显示很有价值。侧枝循环的建立特点与门静脉解剖变异无明显相关性。LGV管径及侧枝血管开放的数量可在一定程度上预测肝炎后肝实质的损害程度。

Correlation Between the MSCT Portal Venous Anatomy and the Different Clinical Features of Portal Hypertension in Cirrhosis

Objective Explore the relationship between the type of the portal vein anatomic variations and the collateral circulation of portal hypertension,and relationship between ascites, hepatic encephalopathy, Child-Pugh grading and the number of collateral vessels opened in cirrhosis.Methods Select hepatitis cirrhosis(n=95) cases examined the upper abdomen enhanced CT, all cases of major branches of the portal vein system and collateral vessels has been reconstructed in MIP, MPR and VR, and then measured diameter of each vessels and observe collateral circulation opened.Based on the Child-Pugh classification and the severity of ascites,95 cases were divided into Child-Pugh A, B and C grade three groups and no ascites, mild, moderate-severe three groups,respectively. Classified portal vein branch anatomic variations ,and use the type of the portal vein anatomic variations,clinical features of liver cirrhosis for statistical analysis.Results Comparison among the six types, the number of collateral vessels opened were no statistically significant(P>0.05).Comparison among the three groups of Child-Pugh A、B、C, the number of collateral vessels opened differences were statistically significant (P<0.05). Comparison among the three groups of no ascites, mild, moderate - severe ascites,the number of collateral vessels opened in the group of no ascites and moderate - severe ascites, the differences were statistically significant (P<0.05),the rest was not statistically significant (P>0.05).Conclusion MSCT portal venography and Image post-processing techniques are great valuable for display the portal venous anatomy.There is no correlation between the features of the collateral circulation and portal vein anatomic variations. The Child-Pugh grading and severity of ascites were related to the number of collateral vessels, Child-Pugh grading higher, more severe ascites, the number of collateral vessels opened more also,so the number of collateral vessels of portal hypertension may predict the liver parenchymal damage of cirrhosis to some extent.