Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita 879-5963, Japan.
Radiographics. 2013 Jan-Feb;33(1):87-100. doi: 10.1148/rg.331125037.
Most gastric varices arise at hepatofugal collateral pathways and drain into the systemic vein through one or both of two different types of portosystemic collateral drainage systems: the gastroesophageal (azygous) venous system and the gastrophrenic venous system. The gastroesophageal venous system consists of gastric varices contiguous with esophageal varices, paraesophageal varices, and the azygos vein, which terminates into the superior vena cava. Gastric varices draining through the gastroesophageal venous system can be treated with endoscopic techniques or creation of a transjugular intrahepatic portosystemic shunt. The gastrophrenic venous system consists of the gastric varices and the left inferior phrenic vein (IPV), which terminates into the left renal vein or the inferior vena cava. The left IPV has abundant anastomoses with peridiaphragmatic and retroperitoneal veins, and these anastomoses can function as drainage pathways from gastric varices. Balloon-occluded retrograde transvenous obliteration is a preferred treatment option for this type of gastric varix. Occasionally, gastric varices can form at the hepatopetal collateral pathway that develops secondary to localized portal hypertension caused by splenic vein occlusion. Splenectomy is often required for the treatment of this type of gastric varix. Multidetector computed tomography permits comprehensive evaluation of these venous drainage systems. Familiarity with and assessment of these draining routes of gastric varices are important for selecting treatment options and interventional techniques.
大多数胃静脉曲张起源于离肝侧侧支循环途径，并通过两种不同类型的门体侧支循环引流系统之一或两者将血液排入体循环静脉：胃食管（奇静脉）静脉系统和胃膈静脉系统。胃食管静脉系统由与食管静脉曲张、食管旁静脉曲张和奇静脉相连的胃静脉曲张组成，奇静脉最终汇入上腔静脉。通过胃食管静脉系统引流的胃静脉曲张可以通过内镜技术或建立经颈静脉肝内门体分流术来治疗。胃膈静脉系统由胃静脉曲张和左膈下静脉（IPV）组成，左膈下静脉最终汇入左肾静脉或下腔静脉。左 IPV 与膈下和腹膜后静脉有丰富的吻合，这些吻合可以作为胃静脉曲张的引流途径。球囊阻塞逆行经静脉闭塞是治疗这种类型胃静脉曲张的首选方法。偶尔，胃静脉曲张可能会在由脾静脉闭塞引起的局部门静脉高压导致的向肝侧侧支循环途径中形成。这种类型的胃静脉曲张通常需要脾切除术治疗。多排 CT 可全面评估这些静脉引流系统。熟悉和评估胃静脉曲张的这些引流途径对于选择治疗方案和介入技术非常重要。
