【摘要】 目的通过16层螺旋CT门静脉成像(CTPV),了解肝硬化门脉高压患者门脉侧支循环状态,探讨其在选择合理手术方式中的价值。方法 73例肝硬化门脉高压患者,分别进行脾切除术(14例)、贲门周围血管离断术(37例)、分流术(17例)和断分流联合术(5例),所有患者术前均行CTPV检查,获得门脉侧支循环血管的清晰图像。结果 CTPV重建门脉侧支循环系统。73例患者中,以胃左、食管旁、脾静脉曲张为主要表现55例(75.3%),伴有脐静脉曲张伴腹壁静脉曲张5例(6.8%),伴有胃短/胃后静脉曲张9例(12.3%),伴有门静脉海绵样变或栓塞9例(12.3%),肠系膜上静脉血管闭塞3例(4.1%)。结论 CTPV重建可较好地显影门静脉侧支循环状态,结合肝功能分级和门脉血流动力学等资料,有助于术者选择合理手术方式,实现门脉高压症的个体化治疗。更多还原

【Abstract】 Objective Checking patients with 16-slice CT portal venography (CTPV), discussing the state of portal collateral circulation in portal hypertension patients, to evaluate the value of CTPV for choosing a reasonable of surgery mode. Methods Seventy-three liver cirrhosis patients with portal hypertension received splenectomy(14 cases), portal azygous disconnection(37 cases), shunt operations(17 cases) or combined with splenorenal shunt and devascularization(5 cases), CTPV were performed in every patient before operation and the clear images of portal collateral vessels were obtained. Results CTPV could reconstruct portal collateral circulation system. In 73 patients, left gastric varices, esophageal and paraesophageal, spleen varices were manifestations in 55 cases(75.3%), abdominal umbilical veins with varicose veins in 5 cases(6.8%), short gastric/post-gastric varices in 9 cases(12.3%), portal vein change or embolism in 9 cases(12.3%), superior mesenteric vein occlusion in 3 cases(4.1%). Conclusion With CTPV reconstruction for collateral circulation of portal vein, combined with liver function and portal hemodynamics and other information, a reasonable surgical approach for portal hypertension in individual treatment can be choosed.更多还原