本文選題：血吸蟲病肝硬化 + 上消化道出血�。� 參考：《中國血吸蟲病防治雜志》2017年03期

【摘要】：目的探討門-體靜脈分流程度在評估血吸蟲病肝硬化上消化道出血中的應(yīng)用。方法以金山醫(yī)院經(jīng)臨床證實的33例血吸蟲病肝硬化上消化道出血患者,及29例血吸蟲病肝硬化非出血患者為研究對象,對其進行上腹部128層螺旋CT掃描。采用薄層塊最大強度投影(TSMIP)、多平面重建(MPR)對門靜脈系進行血管重建,對兩組患者門-體靜脈分流程度進行評分和比較,分析各側(cè)支血管分流程度與血吸蟲病肝硬化上消化道出血的關(guān)系。結(jié)果 33例上消化道出血患者中,側(cè)支血管發(fā)生率如下:胃左靜脈曲張86.4%、胃短靜脈曲張68.2%、食管靜脈曲張50.0%、食管旁靜脈曲張50.0%、胃底靜脈曲張37.9%、胃腎靜脈69.7%、脾腎靜脈51.5%、腹壁靜脈曲張25.8%、網(wǎng)膜靜脈曲張15.2%、脾周靜脈曲張63.6%、附臍靜脈曲張34.8%、腹膜后-椎旁靜脈40.9%、腸系膜靜脈曲張36.4%。出血組食管靜脈、食管旁靜脈、胃左靜脈和胃底靜脈的發(fā)生率和分流程度均明顯大于非出血組(P值均0.05)。結(jié)論 CT門靜脈系成像可精確顯示各類側(cè)支血管的部位、程度及走向。食管靜脈、食管旁靜脈、胃左靜脈和胃底靜脈能較準確地預(yù)測血吸蟲病肝硬化上消化道出血的風險情況,上述側(cè)支血管分流程度越高,上消化道出血危險性就越大。
[Abstract]:Objective to evaluate the application of portal vein shunt in the evaluation of upper gastrointestinal hemorrhage in schistosomiasis cirrhosis. Methods Thirty-three patients with upper gastrointestinal bleeding due to schistosomiasis cirrhosis and 29 patients with non-bleeding schistosomiasis cirrhosis in Jinshan Hospital were examined with 128-slice spiral CT scan. The portal vein system was reconstructed by TSMIP and MPR. The portal venous shunt degree was evaluated and compared between the two groups. To analyze the relationship between collateral shunt degree and upper gastrointestinal hemorrhage due to schistosomiasis cirrhosis. Results among 33 patients with upper gastrointestinal bleeding, The incidences of collateral vessels were as follows: left gastric varices 86.4, gastric short varices 68.2, esophageal varices 50.010, parophagoesophageal varices 50.010, gastric fundus varices 37.9, gastric and renal veins 69.7, splenorenal veins 51.5, abdominal wall varices 25.8, omentum varices 15.2m. Perisplenic varices (63.6%), umbilical veins (34.8%), retroperitoneal and paravertebral veins (40.9%) and mesenteric varices (36.4%). The incidence and shunt degree of esophageal vein, parophagoesophageal vein, left gastric vein and gastric fundus vein in bleeding group were significantly higher than those in non-bleeding group (P < 0.05). Conclusion CT portal system imaging can accurately show the location, degree and direction of all kinds of collateral vessels. Esophageal vein, parophagoesophageal vein, left gastric vein and gastric fundus vein can accurately predict the risk of upper digestive tract hemorrhage in cirrhosis of schistosomiasis. The higher the degree of collateral vessel shunt, the greater the risk of upper digestive tract hemorrhage.
【作者單位】： 上海復(fù)旦大學附屬金山醫(yī)院介入科;
【基金】：上海市衛(wèi)生和計劃生育委員會資助項目(20134410)
【分類號】：R532.21;R573.2;R575.2

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