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目的探讨门-体静脉分流程度在评估血吸虫病肝硬化上消化道出血中的应用。方法以金山医院经临床证实的33例血吸虫病肝硬化上消化道出血患者,及29例血吸虫病肝硬化非出血患者为研究对象,对其进行上腹部128层螺旋CT扫描。采用薄层块最大强度投影(TSMIP)、多平面重建(MPR)对门静脉系进行血管重建,对两组患者门-体静脉分流程度进行评分和比较,分析各侧支血管分流程度与血吸虫病肝硬化上消化道出血的关系。结果 33例上消化道出血患者中,侧支血管发生率如下:胃左静脉曲张86.4%、胃短静脉曲张68.2%、食管静脉曲张50.0%、食管旁静脉曲张50.0%、胃底静脉曲张37.9%、胃肾静脉69.7%、脾肾静脉51.5%、腹壁静脉曲张25.8%、网膜静脉曲张15.2%、脾周静脉曲张63.6%、附脐静脉曲张34.8%、腹膜后-椎旁静脉40.9%、肠系膜静脉曲张36.4%。出血组食管静脉、食管旁静脉、胃左静脉和胃底静脉的发生率和分流程度均明显大于非出血组(P值均<0.05)。结论 CT门静脉系成像可精确显示各类侧支血管的部位、程度及走向。食管静脉、食管旁静脉、胃左静脉和胃底静脉能较准确地预测血吸虫病肝硬化上消化道出血的风险情况,上述侧支血管分流程度越高,上消化道出血危险性就越大。
Objective To explore the application of portal-venous shunt in the evaluation of upper gastrointestinal hemorrhage in cirrhotic patients with schistosomiasis. Methods Thirty-three patients with upper gastrointestinal bleeding from cirrhosis of liver caused by schistosomiasis in Jinshan Hospital and 29 non-hemorrhagic patients with cirrhosis caused by schistosomiasis were enrolled in this study. The upper abdomen was scanned by 128-slice spiral CT. The portal vein was reconstructed by multiplanar reconstruction (MPR) with maximum intensity projection (TSMIP) and multiplanar reconstruction (MPR). The degree of portal vein-vein shunt was evaluated and compared between the two groups. The degree of shunt of each collateral branch was compared with that of schistosomiasis Hardening upper gastrointestinal bleeding relationship. Results Among the 33 patients with upper gastrointestinal bleeding, the incidence of collateral vessels was as follows: 86.4% of gastric left varicose veins, 68.2% of gastric varices, 50.0% of esophageal varices, 50.0% of varices of the esophagus, 37.9% of gastric varices, , 69.7% of gastric and renal veins, 51.5% of splenic and renal veins, 25.8% of abdominal varices, 15.2% of varicose veins, 63.6% of splenic varices, 34.8% of umbilical varices, 40.9% of retroperitoneal-paraspinal varices, Varicose veins 36.4%. The incidence and diversion of esophageal vein, paraesophageal vein, gastric left venous and gastric fundus of bleeding group were significantly higher than that of non-bleeding group (all P <0.05). Conclusion CT portal vein imaging can accurately display the location, extent and orientation of various types of collateral vessels. Esophageal, paraesophageal, gastric left venous and gastric fundus could predict the risk of upper gastrointestinal hemorrhage in cirrhotic patients with schistosomiasis. The higher the degree of collateral blood flow in the collateral vessels, the greater the risk of upper gastrointestinal bleeding.