肝硬化非常见侧支循环临床特点研究

目的 探讨肝硬化患者门体循环之间非常见侧支循环形成的临床特点及意义。方法 对临床确诊为肝硬化的患者运用64排螺旋CT和三维血管成像结合电子胃镜检查,观察其门体循环之间非常见侧支循环的形成。结果 ①700例肝硬化患者中118例(16.86%)存在非常见侧支循环,依次为脾肾静脉分流、胃肾静脉分流、椎旁静脉分流、腹膜后静脉分流、胃脾分流和心膈角静脉分流。②非常见侧支循环形成与肝硬化Child-Pugh分级相关(P<0.01)。③与常见侧支循环形成组比较,非常见侧支循环组较少出现重度食管和(或)胃底静脉曲张、重度门静脉高压性胃病及大量腹水(P<0.01)。④非常见侧支循环组中肝性脑病和慢性血氨升高的发生率高于常见侧支循环组(P<0.01)。结论 ①肝硬化患者中非常见侧支循环并不"非常见";②非常见侧支循环形成与肝功能Child-Pugh分级有关;③非常见侧支循环形成可缓解门静脉高压引起的相关并发症,但增大了肝性脑病和慢性血氨升高的发病率。

Clinical features of uncommon collateral circulation in patients with liver cirrhosis

Objective To investigate the clinical features and significance of uncommon collateral circulation in patients with liver cirrhosis complicated with portal hypertension. Methods Spiral CT angiography using 64 detector rows, three dimensional angiography and electronic gastroscopy were applied for the detection of uncommon collateral circulation in cirrhostic patients complicated with portal hypertension. And the clinical features of the patients were observed. Results Of 700 cirrhostic patients with portal hypertension, uncommon collateral circulation was detected in 118 patients (16.86%), including splenorenal vein shunt, gastrorenal vein shunt, paravertebral veins shunt, retroperitoneal vein shunt, gastro-splenic shunt and cardiophrenic angle vein shunt. The incidence of uncommon collateral circulation was associated with different Child-Pugh grades (P<0.01). The incidence of severe esophageal and/or gastric varices, severe portal hypertensive gastropathy and large quantity of ascites in patients with uncommon collateral circulation was significantly lower than that in patients with common collateral circulation (P<0.01), while the incidence of hepatic encephalopathy and chronic elevated blood ammonia was significantly higher than that in patients with common collateral circulation (P <0.01). Conclusions The incidence of uncommon collateral circulation is not uncommon in the patients with liver cirrhosis. It is associated with Child-Pugh grades. The uncommon collateral circulation can help relieve the complications associated with portal hypertension, but may increase the incidence of hepatic encephalopathy and chronic elevated blood ammonia.