64 排多层螺旋 CT 门静脉造影显示胃静脉曲张侧支循环。
64-row multidetector computed tomography portal venography of gastric variceal collateral circulation.
机构信息
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
出版信息
World J Gastroenterol. 2010 Feb 28;16(8):1003-7. doi: 10.3748/wjg.v16.i8.1003.
AIM
To study characteristics of collateral circulation of gastric varices (GVs) with 64-row multidetector computer tomography portal venography (MDCTPV).
METHODS
64-row MDCTPV with a slice thickness of 0.625 mm and a scanning field from 2 cm above the tracheal bifurcation to the lower edge of the kidney was performed in 86 patients with GVS diagnosed by endoscopy. The computed tomography protocol included unenhanced, arterial and portal vein phases. The MDCTPV was performed on an AW4.3 workstation. GVs were classified into three types according to Sarin's Classification. The afferent and efferent veins of each type of GV were observed.
RESULTS
The afferent venous drainage originated mostly from the left gastric vein alone (LGV) (28/86, 32.59%), or the LGV more than the posterior gastric vein/short gastric vein [LGV > posterior gastric vein/short gastric vein (PGV/SGV)] (22/86, 25.58%), as seen by MDCTPV. The most common efferent venous drainage was via the azygos vein to the superior vena cava (53/86, 61.63%), or via the gastric/splenorenal shunt (37/86, 43.02%) or inferior phrenic vein (8/86, 9.30%) to the inferior vena cava. In patients with gastroesophageal varices type 1, the afferent venous drainage of GV mainly originated from the LGV or LGV > PGV/SGV (43/48, 89.58%), and the efferent venous drainage was mainly via the azygos vein to the super vena cava (43/48, 89.58%), as well as via the gastric/splenorenal shunt (8/48, 16.67%) or inferior phrenic vein (3/48, 6.25%) to the inferior vena cava. In patients with gastroesophageal varices type 2, the afferent venous drainage of the GV mostly came from the PGV/SGV more than the LGV (PGV/SGV > LGV) (8/16, 50%), and the efferent venous drainage was via the azygos vein (10/16, 62.50%) and gastric/splenorenal shunt (9/16, 56.25%). In patients with isolated gastric varices, the main afferent venous drainage was via the PGV/SGV alone (16/22, 72.73%), and the efferent venous drainage was mainly via the gastric/splenorenal shunt (20/22, 90.91%), as well as the inferior phrenic vein (3/23) to the inferior vena cava.
CONCLUSION
MDCTPV can clearly display the afferent and efferent veins of all types of GV, and it could provide useful reference information for the clinical management of GV bleeding.
目的
利用 64 层多层螺旋 CT 门静脉造影术（MDCTPV）研究胃静脉曲张（GVs）侧支循环的特征。
方法
对 86 例经内镜诊断为 GVS 的患者进行 64 层 MDCTPV 检查，层厚 0.625mm，扫描范围从气管分叉上 2cm 到肾下缘。CT 扫描方案包括平扫、动脉期和门静脉期。在 AW4.3 工作站上进行 MDCTPV。根据 Sarin 分类，将 GVs 分为三型。观察每型 GV 的输入和输出静脉。
结果
MDCTPV 显示，86 例患者中，28 例（32.59%）GV 的输入静脉主要来源于左胃静脉（LGV），22 例（25.58%）GV 的输入静脉来源于 LGV 多于胃后静脉/短胃静脉[LGV＞胃后静脉/短胃静脉（PGV/SGV）]。最常见的输出静脉引流途径是通过奇静脉至上腔静脉（53 例，61.63%），或通过胃/脾肾分流（37 例，43.02%）或膈下静脉（8 例，9.30%）至下腔静脉。在食管胃静脉曲张 1 型患者中，GV 的输入静脉主要来源于 LGV 或 LGV＞PGV/SGV（43 例，89.58%），输出静脉主要通过奇静脉至上腔静脉（43 例，89.58%），也可通过胃/脾肾分流（8 例，16.67%）或膈下静脉（3 例，6.25%）至下腔静脉。在食管胃静脉曲张 2 型患者中，GV 的输入静脉主要来源于 PGV/SGV 多于 LGV（PGV/SGV＞LGV）（8 例，50%），输出静脉通过奇静脉（10 例，62.50%）和胃/脾肾分流（9 例，56.25%）。在孤立性胃静脉曲张患者中，主要的输入静脉引流来源于 PGV/SGV（16 例，72.73%），输出静脉主要通过胃/脾肾分流（20 例，90.91%）和膈下静脉（3 例，9.09%）至下腔静脉。
结论
MDCTPV 可清晰显示各型 GV 的输入和输出静脉，可为 GV 出血的临床处理提供有价值的参考信息。
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