摘要
目的通过多层螺旋CT(multi-detecterrowcomputedtomography,MDCT)了解食管胃底静脉曲张及与之相关的侧支循环,为食管胃底静脉曲张破裂出血治疗方案的选择和预后的判断提供客观依据。方法选择51例临床证实的肝硬化门静脉高压患者,其中胃镜显示食管静脉曲张51例,伴胃底静脉曲张31例。对所有患者进行MDCT血管成像,重点观察食管胃底静脉曲张及相关侧支循环。结果MDCT血管成像能清晰地显示肝硬化门体侧支血管,并显示所有食管静脉曲张。MDCT显示胃底静脉曲张32例(62.7%),与胃镜检查结果(31/51,60.8%)比较,两者具有高度一致性,Kappa值为0.876。食管曲张静脉几乎全部由胃左静脉供血,30例(58.8%)单纯由胃左静脉前支供血,21例(41.2%)伴有食管旁静脉;24例(75%)胃底曲张静脉为单纯胃左静脉供血,3例(9.4%)由胃短(胃后)静脉供血,5例(15.6%)为胃短(胃后)和胃左静脉双重供血,双重供血者因胃底静脉曲张和食管静脉曲张常相互交通,所以这些病例胃短(胃后)静脉也同时参与食管静脉曲张的形成。结论MDCT能较清晰地显示食管胃底静脉曲张侧支循环。食管静脉曲张主要由胃左静脉供血,大部分由前支经贲门进入曲张静脉,部分伴有食管旁静脉。胃底静脉曲张大部分由胃左静脉供血,但小部分则由胃短系统供血。
Objective To detect the esophageal and fundal varices and their related collateral ves-sels by multi-detector row CT ( MDCT) in helping to find out the objective evidences for selecting treatment measure and predicting prognosis. Methods Fifty-one patients with clinical diagnosis of cirrhosis were in-cluded in this study. Esophageal varices were confirmed by endoscopy in all patients, of which 31 accompa-nied with fundal varices. All patients underwent MDCT angiography to demonstrate collaterals between the systemic and portal circulation as well as the esophageal varicose. Results Good or excellent image quality was obtained in all patients. Gastric fundal varices were found in 31 of 51 patients (60. 8% )by endoscopies. By MDCT angiography esophageal varies were confirmed in all patients, gastric fundal varices were in 32 of 51 (62. 7% ). There are high degree of concordance Kappa =0. 876 between them. Esophageal varices were supplied mainly by the left gastric vein ( LGV) , by anterior branch of LGV alone in 30 of 51 (58. 8% ). There were paraesophageal veins in 21 of 51 patients (41.2%). Gastric fundal varices were supplied by LGV in 24 of 32 patients (75% ), by short gastric veins /posterior gastric veins in 3 of 32 patients (9. 4% ) and by short gastric veins /posterior gastric veins and LGV together in 5 of 32 patients ( 15. 6% ). Short gas-tric veins and posterior gastric veins participate in forming of esophageal varices in these patients. Conclusion MDCT angiography shows an excellent vascular maps and highly in concordance with endoscopy in terms of the detection of esophageal and gastric fundal varices. Esophagal varices were supplied mainly by LGV, more than half of them were by its anterior branch, and paraesophageal veins participated to it in some patients too. The blood flow in gastric fundal varices were supplied from LGV in most of the patients, and the rest from short gastric veins.
出处
《中华消化内镜杂志》
2005年第2期82-85,共4页
Chinese Journal of Digestive Endoscopy
