门-体分流程度评估血吸虫病肝硬化上消化道出血的应用

发布时间：2018-07-03 17:21

本文选题：血吸虫病肝硬化 + 上消化道出血　；参考：《中国血吸虫病防治杂志》2017年03期

【摘要】：目的探讨门-体静脉分流程度在评估血吸虫病肝硬化上消化道出血中的应用。方法以金山医院经临床证实的33例血吸虫病肝硬化上消化道出血患者,及29例血吸虫病肝硬化非出血患者为研究对象,对其进行上腹部128层螺旋CT扫描。采用薄层块最大强度投影(TSMIP)、多平面重建(MPR)对门静脉系进行血管重建,对两组患者门-体静脉分流程度进行评分和比较,分析各侧支血管分流程度与血吸虫病肝硬化上消化道出血的关系。结果 33例上消化道出血患者中,侧支血管发生率如下:胃左静脉曲张86.4%、胃短静脉曲张68.2%、食管静脉曲张50.0%、食管旁静脉曲张50.0%、胃底静脉曲张37.9%、胃肾静脉69.7%、脾肾静脉51.5%、腹壁静脉曲张25.8%、网膜静脉曲张15.2%、脾周静脉曲张63.6%、附脐静脉曲张34.8%、腹膜后-椎旁静脉40.9%、肠系膜静脉曲张36.4%。出血组食管静脉、食管旁静脉、胃左静脉和胃底静脉的发生率和分流程度均明显大于非出血组(P值均0.05)。结论 CT门静脉系成像可精确显示各类侧支血管的部位、程度及走向。食管静脉、食管旁静脉、胃左静脉和胃底静脉能较准确地预测血吸虫病肝硬化上消化道出血的风险情况,上述侧支血管分流程度越高,上消化道出血危险性就越大。
[Abstract]:Objective to evaluate the application of portal vein shunt in the evaluation of upper gastrointestinal hemorrhage in schistosomiasis cirrhosis. Methods Thirty-three patients with upper gastrointestinal bleeding due to schistosomiasis cirrhosis and 29 patients with non-bleeding schistosomiasis cirrhosis in Jinshan Hospital were examined with 128-slice spiral CT scan. The portal vein system was reconstructed by TSMIP and MPR. The portal venous shunt degree was evaluated and compared between the two groups. To analyze the relationship between collateral shunt degree and upper gastrointestinal hemorrhage due to schistosomiasis cirrhosis. Results among 33 patients with upper gastrointestinal bleeding, The incidences of collateral vessels were as follows: left gastric varices 86.4, gastric short varices 68.2, esophageal varices 50.010, parophagoesophageal varices 50.010, gastric fundus varices 37.9, gastric and renal veins 69.7, splenorenal veins 51.5, abdominal wall varices 25.8, omentum varices 15.2m. Perisplenic varices (63.6%), umbilical veins (34.8%), retroperitoneal and paravertebral veins (40.9%) and mesenteric varices (36.4%). The incidence and shunt degree of esophageal vein, parophagoesophageal vein, left gastric vein and gastric fundus vein in bleeding group were significantly higher than those in non-bleeding group (P < 0.05). Conclusion CT portal system imaging can accurately show the location, degree and direction of all kinds of collateral vessels. Esophageal vein, parophagoesophageal vein, left gastric vein and gastric fundus vein can accurately predict the risk of upper digestive tract hemorrhage in cirrhosis of schistosomiasis. The higher the degree of collateral vessel shunt, the greater the risk of upper digestive tract hemorrhage.
【作者单位】：上海复旦大学附属金山医院介入科;
【基金】：上海市卫生和计划生育委员会资助项目(20134410)
【分类号】：R532.21;R573.2;R575.2

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