| 朱康顺,李征然,孟晓春,何可可,庞鹏飞,关守海,姜在波,黄明声,单鸿.门静脉高压症胃静脉曲张的血流动力学研究:附22例直接门静脉造影结果[J].中国医学影像技术,2006,22(11):1700~1703 |
| 门静脉高压症胃静脉曲张的血流动力学研究:附22例直接门静脉造影结果 |
| Hemodynamics of gastric varices in portal hypertension: direct portography in 22 patients |
| 投稿时间：2006-06-28 修订日期：2006-10-09 |
| DOI： |
| 中文关键词: 门静脉高压 食管和胃静脉曲张 血流动力学 门静脉造影术 |
| 英文关键词:Portal hypertension Esophageal and gastric varices Hemodynamics Portography |
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| 中文摘要: |
| 目的 探讨门静脉高压症胃静脉曲张(GV)的血流动力学变化。方法 经胃镜确诊为GV的22例肝硬化门静脉高压症患者,其中8例为肝癌合并门静脉主干癌栓。根据GV在胃内的位置及其与食管静脉曲张(EV)的关系,内镜将GV分为食管胃静脉曲张(GEV)和孤立的胃静脉曲张(IGV)。GEV又分2个亚型:GEV1型为EV跨过食管胃交界处,沿胃小弯侧向下延伸;GEV2型为EV跨过食管胃交界处,向胃底部延伸。22例患者均采取了经皮肝穿或脾穿门静脉造影,根据门静脉造影表现,比较不同类型GV的血液供应、引流路径及门静脉压力变化。结果 GEV1、GEV2和IGV的发生率分别为54.6%(12例),31.8%(7例)和13.6%(3例)。GEV1型12例中,12例均见胃左静脉供血,胃后静脉参与供血8例(66.7%),胃短静脉参与供血3例(25%),引流路径均经奇静脉系统引流到上腔静脉。GEV2型7例,7例均见有胃左静脉、胃后静脉供血,胃短静脉参与供血4例(57.1%);7例中,5例(71.4%)经胃肾静脉分流道引流到下腔静脉,2例(29.6%)单独经奇静脉系统引流。IGV型3例,均为胃底静脉曲张(IGV1),均见胃左静脉、胃后静脉和胃短静脉供血,引流路径均经胃肾静脉分流道引流。有胃肾分流者门静脉压力为(27.0±4.2) cm水柱,无胃肾分流者门静脉压力为(37.5±5.1) cm水柱(P＜0.001)。结论 GV的血液供应及引流路径与GV的发生部位有关,胃肾静脉分流是胃底静脉曲张(GEV2、IGV1)的主要引流路径。 |
| 英文摘要: |
| Objective To evaluate the hemodynamic changes of gastric varices (GV) in portal hypertension. Methods Twenty-two patients with portal hypertension were diagnosed as GV by endoscopy, in which 8 cases had primary liver malignance with portal vein embolization. GV were endoscopically categorized as gastroesophageal varices (GEV) and isolated gastric varices (IGV) according to GV location in the stomach and the relationship with esophageal varices (EV). GEV were subclassified into 2 groups: type 1 (GEV1): varices joined with EV and extended along the lesser gastric curve below the gastroesophageal junction; and type 2 (GEV2): varices extended from the esophagus below the gastroesphageal junction toward the fundus. Percutaneous transhepatic or transplenic portography was performed in all 22 patients. According to the Results of direct portography, we compared the blood supply, drainage routes and portal venous pressure of the different type of GV. Results In 22 patients, the incidence of GEV1、GEV2 and IGV were 54.6% (12 cases),31.8% (7 cases) and 13.6% (3 cases), respectively. In 12 patients with GEV1, the left gastric vein participated as blood supply of GEV1 in all of them, the posterior gastric vein in 7 patients (31.8%) and the short gastric vein in 3 patients (25%); and in all 12 patients, the main blood drainage route was via azygous system into the super vena cava. In 7 patients with GEV2, the left gastric vein and the posterior gastric vein participated as blood supply in all 7 patients, and the short gastric vein in 4 patients (57.1%); their blood drainage routes included via gastrorenal shunts (GRS) into the inferior vena cava in 5 patients (71.4%) and via azygous system into the super vena cava in 2 patients (29.6%). In 3 patients with isolated gastric fundal varices (IGV1), the left gastric vein, the posterior gastric vein and the short gastric vein participated as blood supply in all 3 patients; their blood drainage routes were via GRS into the inferior vena cava. The portal venous pressure in patients with GRS was (27.0±4.2) cm H2O, whereas in patients without GRS it was (37.5±5.1) cm H2O (P<0.001). Conclusion The blood supply and drainage routes of GV were related to the location of gastric varices. GRS was the main drainage route in the patients with gastric fundal varices (GEV2 and IGV1). |
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