目的:通过128层螺旋CT门静脉成像研究脾肾静脉分流的有无,评价脾肾静脉分流在临床诊断及治疗方面的应用价值。方法:对2014年12月—2016年1月收治的146例肝硬化患者根据脾/胃-肾分流的有无将所筛选患者分成A、B两组,比较两组门静脉、脾静脉、左肾静脉管径平均值和食管下段静脉曲张发生率及严重程度有无差别。结果:A组即有脾肾静脉分流患者为40人,B组即无脾肾分流患者为106人,脾肾静脉分流的发生率约为27.4%;两组患者食管下段静脉曲张严重程度的差异具有统计学意义(χ2=6.24>χ20.05,2=5.99,P<0.05);门脉高压食管静脉曲张的严重程度与脾肾分流的有无呈显著相关性(P=0.01<0.05)。结论:脾肾静脉分流能降低食管胃底静脉曲张的发生率,缓解其严重程度,在门静脉高压行分流术时可以利用已存在的脾肾静脉分流道,达到降低门静脉压力的目的。
Abstract
Objective: To evaluate the application value of splenorenal shunt in clinical diagnosis and treatment through portal vein imaging by 128 slice spiral CT. Methods: According to the presence of splenic/gastric-renal shunt, 146 patients with liver cirrhosis from December 2014 to January 2016 were divided into two groups: group A and group B. Average diameters of the portal vein, the splenic vein and the left renal vein, and the incidence and severity of esophageal varices in two groups were compared. Results: Forty patients in A, and 106 patients in B. The incidence of splenorenal shunt was about 27.4%. The difference between the two groups in the severity of esophageal varices was statistically significant(χ2=6.24>χ20.05, 2=5.99, P<0.05). The severity of esophageal varices was significantly correlated with splenorenal shunt(P=0.01<0.05). Conclusion: The splenorenal shunt can reduce the incidence and relieve the severity of esophageal varices. In the operation of portal hypertension, the existing splenorenal shunt can be used to reduce the pressure of the portal vein.
关键词
肝硬化 /
肾静脉 /
脾静脉 /
体层摄影术 /
X线计算机 /
血管造影术
Key words
Liver cirrhosis /
Renal veins /
Splenic vein /
Tomography, X-ray computed /
Angiography
中图分类号:
R575.2
R814.41
R814.43
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参考文献
[1]Wind P, Alves A, Chevallier JM, et al. Anatomy of spontaneous splenorenal and gastrorenal venous anastomoses[J]. Surg Radiol Anat, 1998, 20(2): 129-134.
[2]Wu Q, Shen L, Chu J, et al. Characterization of uncommon portosystemic collateral circulations in patients with hepatic cirrhosis[J]. Oncol Lett, 2015, 9(1): 347-350.
[3]Kim YJ, Raman SS, Yu NC, et al. Esophageal vareces in cirrhotic patient: evaluation with liver CT[J]. AJR, 2007, 188(1): 139-144.
[4]宗嵘,杨军妍,宋继业,等. 门静脉高压侧支循环的MSCT成像研究[J]. 中国临床医学影像杂志,2013,24(10):747-749.
[5]潘卫东,许瑞云,郑丰平. 自发性脾肾分流对门静脉高压性胃病的影响[J]. 中国内镜杂志,2005,11(5):481-483.
[6]周亚生. 肝硬化CT门静脉血管成像中门静脉侧支血管的临床表现分析[J]. 现代诊断与治疗,2014,25(24):5634-5635.
[7]张硕,余继海,许戈亮. 门静脉高压症血流动力学研究进展[J]. 肝胆外科杂志,2013,21(3):230-232.
[8]Maruyama H, Kondo T, Kiyono S, et al. Influence of splenorenal shunt on long-term outcomes in cirrhosis[J]. Scand J Gastroenterol, 2015, 50(5): 593-600.
[9]Berreta J, Kociak D, Corti R, et al. Predictors of intrahospitalary mortality in the upper gastrointestinal variceal bleeding due to chronic liver disease treated endoscopically[J]. Acta Gastroenterol Latinoam, 2008, 38(1): 43-50.
[10]Kanagawa H, Mima S, Kouyama H, et al. A successfully treated case of fundic varices by retrograde transvenous obliteration with balloon[J]. Nihon Shokakibyo Gakkai Zasshi, 1991, 88(7): 1459-1462.
[11]Kang HK, Jeong YY, Choi JH, et al. Three-dimensional multi-detector row CT portal venography in the evaluation of portosystemic collateral vessels in liver cirrhosis[J]. Radiographics, 2002, 22(5): 1052-1061.
[12]Wu W, He C, Han G. Embolization of spontaneous splenorenal shunt for after-TIPS hepatic encephalopathy in a patient with cirrhosis and variceal bleeding[J]. Hepatology, 2015, 61(5): 1761-1762.
[13]Laleman W, Simon-Talero M, Maleux G, et al. Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: a multicenter survey on safety and efficacy[J]. Hepatology, 2013, 57(6): 2448-2457.