摘要
目的总结门静脉病变的多排螺旋cT检查特征，以及门静脉原发病变与继发病变的CT检查诊断。方法回顾性分析2012年1月至2015年3月西安西电集团医院收治的62例、陕西省核工业二一五医院收治的28例、西安高新医院收治的16例门静脉病变患者的影像学检查资料。采用多排螺旋CT检查进行平扫及增强扫描，记录门静脉病变的多排螺旋cT检查表现、其原发病变和继发病变。结果门静脉宽度改变：106例患者中，门静脉主干管腔增宽45例，主干或分支狭窄39例，闭塞49例（其中伴主干部分增宽21例，伴宽度正常6例）。增宽门静脉管腔直径为1．4～2．2cm，平均1．8cm；因癌栓形成导致门静脉管腔狭窄或闭塞，出现门静脉直径明显增宽，宽度为1．8～4．0cm，平均2．3cm。门静脉瘘和积气：肝动脉-门静脉瘘12例，门静脉右后支-下腔静脉瘘2例，下腔静脉-门静脉瘘及门静脉-肝静脉瘘2例，门静脉积气2例。门静脉闭塞病变位置：门静脉闭塞仅位于门静脉主干4例，位于门静脉左、右分支34例，门静脉主干及分支均有闭塞11例。门静脉恶性狭窄和闭塞分别为29例、42例，良性狭窄和闭塞分别为10例、7例。门静脉增宽原发病：43例肝硬化，2例布-加综合征下腔静脉-门静脉-肝静脉瘘。门静脉良性狭窄和闭塞原发病：肝硬化门静脉血栓、巨大海绵状血管瘤、多囊肝及肝脓肿压迫、肝脓肿导致门静脉炎及真性红细胞增多症致门静脉血栓。肝动脉-门静脉瘘、门静脉-下腔静脉瘘原发病：肝癌、肝硬化，下腔静脉-门静脉瘘及门静脉-肝静脉瘘的原发病均为布-加综合征。门静脉积气原发病：肠系膜上动脉栓塞后肠梗死和急性胃扩张。58例患者形成门腔静脉侧支循环（部分患者合并多个部位的静脉曲张或分流）；44例患者形成腹腔积液；12例形成门静脉海绵样变；5例形成肠壁缺血水肿；19例患者伴发肝内胆管扩张，其中恶性肿瘤引起胆管梗阻17例，肝硬化门静脉海绵样变伴肝内胆管扩张（门静脉高压性胆管病）2例。结论门静脉病变多排螺旋CT检查主要表现为门静脉狭窄、闭塞或扩张、积气，其继发病变表现为门-腔静脉侧支循环形成及门静脉海绵样变、肠缺血以及门静脉高压性胆病；其原发病变多样，以肝硬化和恶性肿瘤为主。多排螺旋CT检查可清楚显示门静脉病变，对其原发病变与继发病变可进行准确诊断。
Objective To summarize the characteristics of muhi-slice computed tomography （MSCT） of portal vein diseases and investigate the CT diagnosis of its primary and secondary diseases. Methods The imaging data of 62 patients from Xi＇an Xidian Group Hospital, 28 patients from Nuclear Industry 215 Hospital of Shanxi Province and 16 patients from Xi＇an Gaoxin Hospital with portal vein diseases from January 2012 to March 2015 were retrospectively analyzed. The CT findings, primary and secondary diseases of portal vein lesions were recorded through plain scan and enhanced scan of MSCT. Results Changes in the width of portal vein： among 106 patients, dilation of main portal vein was detected in 45 cases, stenosis of stem or branches of portal vein in 39 cases, portal vein obstruction in 49 cases （21 patients accompanied with enlargement in stem of portal vein and 6 patients with normal width）. The diameters of dilated portal vein were 1.4-2.2 cm with a mean diameter of 1.8 cm. The diameters of portal vein with stenosis and occlusion caused by carcinomas were 1.8-4.0 cm with a mean diameter of 2.3cm. Portal vein fistula and pneumatosis： hepatic aftery-portal vein fistulas were detected in 12 patients, posterior fight branches of portal vein-inferior vena cava fistulas in 2 patients, inferior vena cava- portal vein fistulas and portal-hepatic vein fistulas in 2 patients, pneumatosis in 2 patients. Lesions of portal veinocclusions： occlusions located at main portal veins were detected in 4 cases, left and right branches in 34 cases, both main portal veins and left or right branches in 11 cases. Malignant stenosis and occlusion were detected in 29 and 42 cases, benign stenosis and occlusion were detected in 10 and 7 cases, respectively. Protopathies of portal vein dilation： there were 43 patients with liver cirrhosis and 2 patients with inferior vena cava-portal vein-hepatic vein fistula of Budd-Chiari syndrome. Protopathies of benign stenosis and occlusion ： portal vein thrombosis in liver cirrhosis, giant cavernous haemangioma, polycystic disease of liver, pylephlebitis caused by liver abscess, portal vein thrombosis caused by polycythemia vera. Protopathies of hepatic arte .ry portal vein fistula and portal vein- inferior vena cava fistula： liver cancer and liver cirrhosis, protopathy of inferior vena cava-portal vein fistula and portal vein-hepatic vein fistula were Budd-Chiari syndrome. Protopathies of pneumatosis ： intestinal infarction after superior mesenteric artery embolus and acute gastric dilatation. Portacaval collateral circulation occurred in 58 patients （partial patients complicated with multi-point varices and shunts ）, ascites in 44 patients, portal vein cavernous transformation in 12 patients, ischemia and edema of intestinal wall in 5 patients, intrahepatic cholangiectasis in 19 patients including 17 cases of biliary obstruction caused by malignant tumors and 2 cases of portal vein cavernous transformation complicated with intrahepatic cholangiectasis （portal hypertensive biliopathy）. Conclusions The MSCT for portal vein diseases is presented as portal vein stenosis, occlusion or dilation, pneumatosis. Secondary lesions are portacaval collateral circulation, portal vein cavernous transformation, intestinal ischemia and portal hypertensive biliopathy, and primary lesions are mainly liver cirrhosis and malignant tumors. MSCT can show clearly the portal vein lesions and diagnose accurately its primary and secondary lesions.
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2015年第9期766-770,共5页
Chinese Journal of Digestive Surgery
基金
基金项目：西安市科技局科技项目基金（SF1417）
