经皮脾门静脉核素显像、B超及胃镜对肝硬化 门脉高压诊断价值的对比研究

摘要

To investigate and evaluate the methods for the dignosis ofcirrhotics with portal hypertension. Spleno-portal vein shape and portosystemic shunt index（PSSI）were determined through portal circulation imaging by using intrasplenic injection of 99m Tc-Phytate.Comparision was also made with gastroscopy and ultrasonography.Results showed that the liver cirrhostics with portal hypertension were separated into four type，namely nonshunt，shunt，with collateral vein and full-extrahepatic shunt type by splenoportoscintigraphy. The PSSI for controls was 0.192±0.068，chronic hepatitis was 0.246±0.057，cirrhosis was 0.541±0.082，cirrhosis Child-pugh A 0.384±0.052，B 0.523±0.07，C 0.680±0.081.If the threshold for cirrhosis was set at PSSI＞0.36，the sensitivity was 91.7％，superior to the above other methods.It suggests that splenoportoscintigraphy is capable showing splenoportal circulation shape and helpful in dignosing cirrhosis at its early stage and evaluating prognosis.%为探讨经脾门静脉核素显像、胃镜及B超检查在肝硬化门脉高压诊断中的价值及其相关性，采用99m锝-植酸钠（99mTc-Phytate）经脾细针穿刺给药法对58例肝病与非肝病患者进行了经脾门静脉单光子发射计算机断层（SPECT）显像，以观察及门脉循环情况，计算门体分流指数（PSSI），并与胃镜、B超进行比较。结果显示，经脾门静脉核素显像可将肝硬化门脉高压分为四型，即无分流型、有分流型（包括肝内、外分流）、有侧支循环型、完全肝外分流型。PSSI值非肝病对照组为0.192±0.068，慢性肝病组为0.246±0.057，肝硬化门脉高压组为0.541±0.082。按肝硬化ChildA、B、C分级，三组分别为0.384±0.052、0.523±0.072、0.680±0.081。若以PSSI＞0.36为判别阈，肝硬化组总阳性率为91.7％，其诊断价值明显优于B超及胃镜。提示经脾门静脉核素显像既能显示脾门静脉形态及侧支循环，又能测定PSSI，有助于肝硬化的早期诊断、治疗选择及预后判断。