原发性肝癌门静脉海绵样变的螺旋CT表现

目的 探讨原发性肝癌门静脉栓塞后侧支开放的螺旋CT表现及病理基础。材料与方法 随机搜集50例原发性肝癌伴门静脉主干栓塞病例（其中门脉主干完全栓塞27例，不全栓塞23例），另50例肝硬化门静脉高压病例作为对照组，其中1例合并肝癌，但未出现门脉栓塞。结果 门脉完全栓塞组中，胆囊周围侧支（胆丛）开放者15例（55．6％），胆总管周围侧支开放者21例（77．8％），胃小弯侧支开放者20例（74．1％）；不全栓塞组上述侧支开放分别为5例（21．7％），8例（34．8％）及11例（47．8％）。对照组胃小弯侧支静脉开放者36例（72％），未见胆总管周围及胆丛侧支开放。结论 （1）胆丛和胆总管周围侧支为门脉栓塞后特有的一组侧支循环途径，而胃小弯侧支在单纯门脉高压及门脉栓塞后均可出现，不具特征性。（2）门脉栓塞是形成胆丛和胆总管周围侧支的一个重要因素，而且门静脉海棉样变的形成与阻塞程度有关，阻塞越重，发生机会越大。

Spiral CT Manifestations of Cavernous Transformation of the Portal Vein in Primary Hepatic Carcinoma

Objective To investigate the spiral CT manifestations and their pathological bases of cavernous transformation of the portal vein (CTPV) due to tumor thrombosis in primary hepatic carcinoma (PHC).Materials and Methods Fifty patients of PHC with portal obstruction were randomly collected, and divided into complete and incomplete obstructive groups. Another 50 cirrhotic patients with portal hypertension but without portal obstruction were used as control group.Results In complete obstructive group (n=27), pericholecystic collaterals (n=15, 55.6%), paracholedochal collaterals (n=21, 77.8%) and collaterals at lesser gastric curvature (n=20, 74.1%) were demonstrated, while in incomplete obstructive group (n=23), the incidence of the above collaterals were 21.7% (n=5), 34.8% (n=8) and 47.8% (n=11), respectively. In control group, except for collaterals at lesser gastric curvature (n=36, 72%) no other collaterals could be found. Conclusion (1) Pericholecystic and paracholedochal collaterals are characteristic collateral circulation secondary to tumor thrombosis in PHC, while collaterals at lesser gastric curvature can be demonstrated in both portal obstruction and simple portal hypertension. (2) Portal obstruction is an important factor for the development of pericholecystic and paracholedochal collaterals, and the formation of CTPV is relevant to the severity of portal obstruction, the severer the obstruction is, the more likely the CTPV will develop.