胡海东，张见增

216例肝硬化门静脉高压症患者CT血管成像门静脉侧支血管表现研究

胡海东，张见增

目的探讨肝硬化患者CT门静脉血管成像中门静脉侧支血管表现，为临床诊断提供依据。方法回顾性研究2013年1月～2014年1月本院收治的216例临床诊断为肝硬化门静脉高压症患者的临床和CT检查资料，针对患者CT门静脉血管成像和门静脉侧支血管三维重建图像进行分析。结果216例患者中，肝硬化门体分流侧支血管的分布、走行及解剖毗邻关系在CT门静脉血管成像图像上都能得到良好、直观的显示，其中胃左静脉曲张者172例（79.63%），食管下段静脉曲张者100例（46.30%），食管旁静脉曲张者51例（23.61%），胃/脾肾静脉分流者50例（23.15%），附脐静脉及腹壁静脉曲张者36例（16.67%）；胃/脾肾静脉分流患者门静脉和脾静脉直径分别为（12.64±1.12）mm和（18.72±3.48）mm，与无分流患者比较有统计学差异[分别为（19.56±5.64）mm和（13.47±2.35）mm，P<0.05]。结论对肝硬化门脉高压患者行CT门静脉血管成像检查能够对患者侧支循环的部位、严重程度等进行观察，并作出准确的判断。

肝硬化；门脉高压症；CT血管成像；门静脉

【Abstract】ObjectiveTo explore the imaging manifestation of portal collateral vessels by CT angiography in patients with liver cirrhosis.MethodsA retrospective study were carried out in 216 patients with cirrhotic portal hypertension，who were treated in our hospital from January 2013 to January 2014.The clinical data，CT portal angiography and three dimensional reconstruction image of portal collateral vessels in all patients were analyzed.ResultsThe distribution，pathway and anatomy of portosystemic collateral vessels were well shown by CT portal angiography in all 216 patients；Among them，there were 172（79.63%）patients with left gastric varices，100（46.30%）with lower esophageal varices，51 cases（23.61%）with paraesophageal varices，50 cases（23.15%）with gastro-renal shunt and/or splenorenal shunt，and 36 cases（16.67%）with paraumbilical varices and varicosity of abdominal wall；There existed significant difference in the diameter of portal vein and splenic vein between patients with gastro-renal shunt and/or splenorenal shunt[（12.64±1.12）mm and（18.72±3.48）mm，respectively] and patients without shunt[（19.56±5.64）mm and（13.47±2.35）mm，respectively，P<0.05].ConclusionCT portal angiography can clearly show the distribution and severity of collateral vessel in patients with cirrhotic portal hypertension，which can help accurate diagnosis.

【Key words】Liver cirrhosis；Portal hypertension；CT angiography；Portal vein

肝硬化是全球常见病和死亡的主要原因之一[1]，是多种病因导致肝脏损伤的最终结果，其特点是肝实质损伤而引起的广泛的肝纤维化和结节状再生[2]。常见原因是HBV和HCV感染或者慢性酒精中毒，其次是胆汁淤积、非酒精性脂肪性肝病等。我国肝硬化发病患者呈现逐年上升的趋势，在中晚期肝硬化患者中有70%以上会出现显著的门静脉高压现象[3，4]。中晚期肝硬化常伴有门脉高压，门静脉系统的血液通过门体静脉吻合侧支血管回流入体循环，由此形成了多条离肝性的侧支循环通道[5]。在实施手术或介入治疗前要特别考虑到这些血管，而且这些血管损伤破裂将导致大出血[6]。……