并发消化道出血的先天性门体分流畸形8例影像学特征病例系列报告

发布时间：2018-03-25 13:22

本文选题：先天性门体分流　切入点：Abernethy畸形　出处：《中国循证儿科杂志》2017年05期

【摘要】：目的探讨合并消化道出血的先天性门体分流畸形的影像学特征,以提高对该畸形的认识。方法纳入复旦大学附属儿科医院病历系统中先天性门体分流且病史中有消化道出血症状的病例,采集性别、年龄、临床表现、CTA和MRA影像学资料、外科手术结局。CTA为GE Light speed 64排螺旋CT扫描仪,MRA为Siemens Avanto 1.5 T扫描仪,提取纳入病例的CTA原始图像,以1.25 mm层厚/0.625 mm层间隔重建,传入后处理工作站进行多平面重建;提取纳入病例的MRA原始图像,传入MR工作站进行后期多平面重建;由2名从事儿科影像诊断10年以上医生独立读片,观察门静脉及其属支的形态及走行,异常门体分流位置、途径,髂静脉、下腔静脉及肠管、肠壁血管分布。结果 2008年3月至2017年1月符合本文病例纳入标准的连续病例8例,男6例,年龄3月至10岁,7例贫血,7例便血,1例呕血。8例均行CTA检查,其中2例同时行MRA检查。截止出院时,6例行手术治疗,2例随访观察。8例先天性门体分流畸形患儿均为肝外型门体分流,2例肝外型Ⅰ型,6例为Ⅱ型。以便血为表现的7例中,髂内静脉、直肠上静脉及结肠静脉扩张扭曲;以呕血为表现的1例,脾静脉和肠系膜上静脉汇合后通过胃冠状静脉汇入左肾静脉,胃冠状静脉显著扩张、扭曲。结论合并便血的先天性门体分流大部分通过肠系膜下静脉与髂静脉异常沟通,发生便血的比例高。
[Abstract]:Objective to investigate the congenital portosystemic shunt combined with hemorrhage of digestive tract malformation imaging features, in order to improve the understanding of this deformity. Methods included symptomatic gastrointestinal bleeding cases, congenital portal Paediatrics Hospital Affiliated to Fudan University medical record system in history and distributary acquisition of gender, age, clinical manifestations, imaging data of CTA and MRA, surgery.CTA GE Light speed for the surgical outcome of 64 slice spiral CT scanner, MRA Siemens Avanto 1.5 T scanner, CTA extraction into the original image case, with a thickness of 1.25 mm /0.625 mm reconstruction interval, the incoming postprocessing workstation for multi planar reconstruction; extracting the original image into the MRA case, the incoming MR workstation for multi planar later reconstruction; by 2 more than 10 years engaged in pediatric imaging diagnosis of doctor independent reading, observation of portal vein and its tributaries form and running, the abnormal position of portosystemic shunt, iliac vein approach, The inferior vena cava and intestine, bowel wall vascularity. 8 consecutive cases from March 2008 to January 2017 results in line with the inclusion criteria, 6 cases were male, age from March to 10, 7 cases of anemia, 7 cases of blood in the stool, 1 cases of hematemesis.8 cases were examined by CTA, 2 cases underwent MRA examination. The hospital stop, 6 cases of surgical treatment, follow-up observation of 2 cases of.8 patients with congenital portosystemic shunt deformity patients had extrahepatic portosystemic shunt, 2 cases of extrahepatic type, 6 cases of type II. In 7 cases with hematochezia, iliac vein, superior rectal vein and vein dilatation in colonic distortion; 1 cases of haematemesis, splenic vein and superior mesenteric vein after confluence through gastric coronary vein enters the left renal vein, gastric coronary vein dilation, with distortion. Conclusion hematochezia congenital portosystemic shunt mostly through vein and iliac vein inferior mesenteric abnormal communication, bloody stool is high.

【作者单位】：复旦大学附属儿科医院放射科;厦门市儿科医院放射科;
【分类号】：R445.2;R725.7

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