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增强 CT 对肝细胞癌合并胃食管静脉曲张患者管理的疗效。

The efficacy of contrast-enhanced computed tomography on the management of gastroesophageal varices in patients with hepatocellular carcinoma.

机构信息

Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan.

Translational Research and Development Center, Chiba University Hospital, Chiba, Japan.

出版信息

Sci Rep. 2022 Dec 1;12(1):20726. doi: 10.1038/s41598-022-25350-8.

DOI:10.1038/s41598-022-25350-8
PMID:36456830
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9715668/
Abstract

The screening of gastroesophageal varices (GEV) is critical in hepatocellular carcinoma (HCC) management. Contrast-enhanced computed tomography (CECT) is often performed in patients with HCC. Therefore, this study aimed to examine the use of CECT in screening for GEV and predicting GEV bleeding. This retrospective study enrolled 312 consecutive patients who are initially diagnosed with HCC, measured the lower esophageal (EIV) and fundal intramural vessel (FIV) diameter on CECT, examined the changes after 1, 2, and 3 years, and verified the relationship with GEV bleeding. The EIV and FIV diameter on CECT correlates well with endoscopic variceal classification. EIV significantly worsened after 2 and 3 years. FIV showed worsening at both 1, 2, and 3 years. Cumulative GEV bleeding rates were 3.7% at 1 year and 6.2% at 3 years. The multivariate analysis revealed that EIV, FIV, and portal vein tumor thrombus were associated with GEV bleeding. Furthermore, EIV deterioration at 1, 2, and 3 years correlated with GEV bleeding. In conclusion, CECT is useful in variceal management during the longitudinal clinical course of HCC, and has the potential to decrease screening endoscopy. With deterioration in EIV, treatments should be considered due to a high-risk GEV bleeding.

摘要

食管胃静脉曲张（GEV）的筛查在肝细胞癌（HCC）管理中至关重要。增强 CT （CECT）常用于 HCC 患者。因此，本研究旨在研究 CECT 在 GEV 筛查和预测 GEV 出血中的应用。这项回顾性研究纳入了 312 例连续确诊 HCC 的患者，在 CECT 上测量食管下段（EIV）和胃底壁内血管（FIV）直径，在 1、2 和 3 年后检查变化，并验证与 GEV 出血的关系。CECT 上的 EIV 和 FIV 直径与内镜静脉曲张分级密切相关。EIV 在 2 年后和 3 年后明显恶化。FIV 在 1、2 和 3 年后均显示恶化。1 年后的累积 GEV 出血率为 3.7%，3 年后为 6.2%。多变量分析显示，EIV、FIV 和门静脉癌栓与 GEV 出血相关。此外，EIV 在 1、2 和 3 年内的恶化与 GEV 出血相关。总之，CECT 在 HCC 的纵向临床病程中对静脉曲张的管理有用，并有可能减少筛查性内镜检查。随着 EIV 的恶化，由于 GEV 出血风险较高，应考虑进行治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/92aa/9715668/3f3ce9c199bc/41598_2022_25350_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/92aa/9715668/3294fbe1058c/41598_2022_25350_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/92aa/9715668/3f3ce9c199bc/41598_2022_25350_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/92aa/9715668/3294fbe1058c/41598_2022_25350_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/92aa/9715668/3f3ce9c199bc/41598_2022_25350_Fig2_HTML.jpg

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