CT门静脉成像对门静脉高压食管胃底静脉曲张诊断的临床意义

摘要

Objective To investigate the clinical value of multi-slice CT portography (MSCTP) in diagnosing esophageal and gastric varication caused by cirrhosis and portal hypertension. Methods The data of 60 patients with liver cirrhosis and portal hypertension from April 2015 to July were enrolled in this prospective study. All the patients were examined with gastroscopy and MSCTP. The positive rate of MSCTP and endoscopic esophageal and gastric varication, and the consistency of esophageal varication grading were analyzed with Kappa test.χ2 test was used to detect the difference in esophageal and gastric varication Sarin types between MSCTP and gastroscopy. Results The positive rate of MSCTP examination was highly consistent with that of gastroscopy (κ=0 . 735 , P<0 . 001 ) . MSCTP was highly consistent with gastroscopy for evaluating esophageal varication ( κ=0.728, P<0.001), there was no statistically significant difference in esophageal and gastric varication Sarin types between MSCTP and gastroscopy (P>0.05). MSCTP found 13 cases of shunt, including gastric renal shunt in 4 cases, splenorenal shunt in 9 cases, and umbilical vein recanalization in 3 cases. Conclusion MSCTP can well show esophageal and gastric varication in the patients with liver cirrhosis and portal hypertension, and is in good agreement with the observation in gastroscopy. The cavity vein and collateral can be well evaluated on MSCTP. MSCTP can provide reliable evidence for clinical diagnosis.%目的 探讨CT门静脉成像(MSCTP)在肝硬化门静脉高压病人中显示食管及胃底静脉曲张的临床应用价值.方法 本前瞻性研究纳入2015年4—7月临床诊断为肝硬化门静脉高压的60例病人,均行MSCTP及胃镜检查.采用Kappa检验分析MSCTP与胃镜对食管、胃底静脉曲张诊断阳性率及对食管静脉曲张分级程度的一致性,采用χ2检验对MSCTP与胃镜诊断食管、胃底静脉曲张Sarin分型进行比较.结果 MSCTP与胃镜在诊断食管、胃底静脉曲张的阳性率方面具有较好的一致性(κ=0.735,P<0.001),在诊断食管静脉曲张分级中也具有较好的一致性(κ=0.728,P<0.001).MSCTP与胃镜诊断食管、胃底静脉曲张Sarin分型的差异无统计学意义(P>0.05).MSCTP发现13例存在分流道,其中胃肾分流4例,脾肾分流9例,脐静脉再通3例.结论 MSCTP对于肝硬化门静脉高压病人食管及胃底静脉曲张显示良好,与胃镜诊断具有较好的一致性,并能更好地观察到腔外静脉侧支情况,可为临床诊断提供可靠的佐证.