CT 門靜脈成像診斷胃底靜脈曲張側支循環的價值
趙麗琴 賀文 趙紅 于永征
【摘要】 目的 探討CT 門靜脈成像( CTPV) 在胃底靜脈曲張( GV) 診斷中的價值。
方法 回顧性分析經內鏡證實的40 例肝硬化患者GV 的CTPV 類型、程度及血供特點, 并與內鏡曲張
靜脈的形態、部位相對照。結果 GV 的形態在胃鏡上分為迂曲形、結節形和瘤形, CTPV 上相應為迂
曲狀、結節狀和瘤狀, 胃鏡下GV 的形態為迂曲形21 例, CTPV 表現為迂曲狀19 例, 結節狀2 例; 胃鏡
下結節形14 例中, CTPV 上表現為迂曲狀1 例, 結節狀13 例; 胃鏡下瘤形5 例, CTPV 均表現為瘤狀。
2 種方法對GV 形態對照的一致性檢驗( Kappa = 0. 873, P < 0. 01) , 有明顯統計學意義; GV 在胃鏡上
的部位與其形態及CTPV 的血供有明顯的對應關系, 食管-胃靜脈曲張1 型( GEV1 ) , GV 多為迂曲形
( 19 /25) , CTPV 的血供主要為胃左靜脈( LGV) 單獨或為主供血( 21 /25 ) ; 食管-胃靜脈曲張2 型
( GEV2) GV 主要為結節形( 5 / 7) , CTPV 的血供為LGV 及胃后靜脈( PGV) 和( 或) 胃短靜脈( SGV) 均
參與GV 的供血, 以后者居多( 5 /7 ) ; 孤立性胃靜脈曲張( IGV) 型GV 的形態為結節形( 4 /8) 和瘤形
( 3 /8) , 以PGV 和( 或) SGV 單獨或為主供血( 8 /8 ) 。此外, GEV2 型和IGV 型伴胃和( 或) 脾腎分流
的幾率較大( 5 /7、6 /8) 。結論 CTPV 可無創性地顯示胃底靜脈曲張側支循環的類型、特點, 對臨床
治療方案的選擇及預后的評估有重要價值。
【關鍵詞】 肝硬化; 高血壓, 門靜脈; 食管和胃靜脈曲張; 體層攝影術, X 線計算機
The value of CT portal venogr aphy in the dia gnosis of collateral veins in patients with gastric var ices
ZHAO Li-qin* , HE Wen, ZHAO Hong, YU Yong-zheng. * Department of Radiology, Beijing Friendship
Hospital Affilia ted of Capital University of Medica l Science, Beijing 100050, China
Corresponding author: HE Wen, Email: hewen1724@sina. com
【Abstra ct 】 Objective To investigate the types and characteristics of gastric varices ( GV) on CT
portal venography ( CTPV) and its correlation with endoscopic findings. Methods Forty patients with
hepatocirrhosis were analyzed retrospectively . The gastric varices′types, degrees, and extension on CTPV
were studied in relation to the endoscopics′findings. Result s The shapes of gastric varices on CTPV had
three types : circuity, nodosity and nubbly, which were highly correlated with the findings of the endoscopics
( K = 0. 873, P < 0. 01 ) . Among the 21 cases of gastric varices with endoscopic appearance of circuity,
19 of them had the same appearance, 2 of them with the appearance of nodosity on CTPV. There were
14 cases with nodosity appearance on endoscopy, 13 cases had nodosity and 1 had circuity on CTPV. And
there were 5 cases whose GV shape were nubbly on both endoscopy and CTPV. The location of GV on
endscopy was related to its shapes on endoscopy and the blood supply of GV on CTPV. Ingastroesophageal
varices typeⅠ( GEV1) , the shapes of mostGV were circuity( 19 /25) , and the blood supply was often derived
from the left gastric veins ( LGV) ( 21 / 25) . In gastroesophageal varices type Ⅱ( GEV2) , the shapes were
mainly nodosity( 5 /7) and the blood supply could come from both LGV and post and( or) short gastric veins,
and oftencame from the latter( 5 /7) . In isolated gastric varices ( IGV) , its shapes were nodosity( 4 /8) and
nubbly( 3 /8) , and it often came from the post and( or) short gastric veins( 8 /8) . The gastrorenal and( or)
splenorenal shunt was tend to occur in GEV2 and IGV type ( 4 /8, 3 /8 ) . Conclusion CTPV is an noninvasive
methods , which can reveal the gastric varices and the types of porto-systemic corralation. It is of
important value in the selection of therapy and the evaluation of prognosis.
【Key wor ds】 Cirrhosis; Hypertension, portal; Esophageal and gastric varices; Tomography,
X-ray computed

CT 門靜脈成像診斷胃底靜脈曲張側支循環的價值--腹部.rar