CT門靜脈血管成像與內鏡診斷胃食管靜脈曲張的比較_《華西醫學》

作者：

陳旭平 ¹ ,  蔣志凌 ¹ , 陳霞 ¹ , 付丹 ¹ , 劉軍 ²

成都市第六人民醫院（成都，610051）1消化內科，2 CT室;

關鍵詞：

門靜脈高壓胃食管靜脈曲張門靜脈造影術內鏡體層攝影術，X線計算機

DOI：

10.7507/1002-0179.20130076

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　比較CT門靜脈血管成像（CTP）與內鏡診斷肝硬化胃食管靜脈曲張的效果，探討CTP對肝硬化門靜脈高壓側支循環血管的顯示及其在隨訪中的價值。方法　對2010年1月－2011年12月收治的43例肝硬化患者行多排螺旋CT增強掃描門靜脈血管成像，觀察胃食管靜脈曲張程度，及有無其他側支開放，并在4周內行內鏡檢查，了解胃食管靜脈曲張的程度。結果　43例患者中有33例經胃鏡確診食管靜脈曲張，其中CTP診斷與胃鏡相符29例；胃鏡診斷胃底靜脈曲張14例，其中有12例CTP診斷與之相符；CTP診斷胃食管靜脈曲張與內鏡有較好的相關性和一致性，但在判斷食管靜脈曲張部位上與胃鏡一致性較差。結論　對肝硬化患者可采用CTP進行隨訪，以評估胃食管靜脈曲張出血風險，可減少不必要的內鏡隨訪。

引用本文： 陳旭平,蔣志凌,陳霞,付丹,劉軍. CT門靜脈血管成像與內鏡診斷胃食管靜脈曲張的比較. 華西醫學, 2013, 28(2): 240-243. doi: 10.7507/1002-0179.20130076 復制

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6.	Merli M, Nicolini G, Angeloni S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients[J]. J Hepatol, 2003, 38(3): 266-272.
7.	中華醫學會. 食管胃靜脈曲張出血的診治建議(草案)[J].中華內科雜志, 2006, 45(6): 524-526．.
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10.	Rydberg J, Buckwalter KA, Caldemeyer KS, et al. Multisection CT: scanning techniques and clinical applications[J]. Radiographics, 2000, 20(6): 1787-1806.
11.	Fishman EK. From the RSNA refresher courses: CT angiography: clinical applications in the abdomen[J]. Radiographics, 2001, 21(Spec): 3-16.
12.	靳勇, 吳云林, 王蕾, 等. 多層螺旋CT門靜脈血管成像與內鏡對食管、胃靜脈曲張診斷的比較研究[J]. 中華消化雜志, 2007, 27(2): 78-82.
13.	Aqarwal A, Jain M. Multidetector CT portal venography in evaluation of portosystemic collateral vessels[J]. J Med Imaging Radiat Oncol, 2008, 52(1): 4-9.
14.	程燕, 宋彬, 寧剛, 等. 多排螺旋CT血管成像技術對肝硬化門脈高壓側支循環血管的評價[J]. 放射學實踐, 2009, 24(6): 584-587.
15.	Moubarak E, Bouvier A, Boursier J, et al. Portosystemic collateral vessels in liver cirrhosis: a three-dimensional MDCT pictorial review[J]. Abdom Imaging, 2012, 37(5): 746-766.
16.	何代霞, 陳旭平, 蔣志凌. Child-Pugh分級對失代償期肝硬化預后的評估[J]. 華西醫學, 2009, 24(4): 894-896.
17.	Zardi EM, Uwechie V, Caccavo D, et al. Portosystemic shunts in a large cohort of patients with liver cirrhosis: detection rate and clinical relevance[J]. J Gastroenterol, 2009, 44(1): 76-83.
18.	吳柳, 范竹萍, 顧海燕, 等. 多層螺旋CT檢查在肝硬化患者食管靜脈曲張診斷和分級中的價值[J]. 胃腸病學, 2009, 14(1): 12-15.

1. 　British Society of Gastroenterology. UK guidelines on the management of variceal haemorrhage in cirrhotic patients[J]. Gut, 2000, 46(Suppl 3): 1-15.
2. 　Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices[J]. Br J Surg, 1973, 60: 646-649.
3. 　中華醫學會消化內鏡分會.食管胃靜脈曲張內鏡下診斷和治療規范[J]. 中華消化內鏡雜志, 2004, 21(3): 149-151.
4. 　Garcia-Tsao G, Sanyal AJ, Grace ND, et al. The Practice Guidelines Committee of the American Association for the Study of Liver Diseases and the Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis[J]. Am J Gastroenterol, 2007, 102(9): 2086-2102.
5. 　The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the ?rst variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices: a prospective multicenter study[J]. N Engl J Med, 1988, 319(15): 983-989.
6. 　Merli M, Nicolini G, Angeloni S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients[J]. J Hepatol, 2003, 38(3): 266-272.
7. 　中華醫學會. 食管胃靜脈曲張出血的診治建議(草案)[J].中華內科雜志, 2006, 45(6): 524-526．.
8. 　Kim SH, Kim YJ, Lee JM, et al. Esophageal varices in patients with cirrhosis: multidetector CT esophagography-comparison with endoscopy[J]. Radiology, 2007, 242(3): 759-768.
9. 　D’Amico G, Morabito A. Noninvasive markers of esophageal varices: another round, not the last[J]. Hepatology, 2004, 39(1): 30-34.
10. 　Rydberg J, Buckwalter KA, Caldemeyer KS, et al. Multisection CT: scanning techniques and clinical applications[J]. Radiographics, 2000, 20(6): 1787-1806.
11. 　Fishman EK. From the RSNA refresher courses: CT angiography: clinical applications in the abdomen[J]. Radiographics, 2001, 21(Spec): 3-16.
12. 　靳勇, 吳云林, 王蕾, 等. 多層螺旋CT門靜脈血管成像與內鏡對食管、胃靜脈曲張診斷的比較研究[J]. 中華消化雜志, 2007, 27(2): 78-82.
13. 　Aqarwal A, Jain M. Multidetector CT portal venography in evaluation of portosystemic collateral vessels[J]. J Med Imaging Radiat Oncol, 2008, 52(1): 4-9.
14. 　程燕, 宋彬, 寧剛, 等. 多排螺旋CT血管成像技術對肝硬化門脈高壓側支循環血管的評價[J]. 放射學實踐, 2009, 24(6): 584-587.
15. 　Moubarak E, Bouvier A, Boursier J, et al. Portosystemic collateral vessels in liver cirrhosis: a three-dimensional MDCT pictorial review[J]. Abdom Imaging, 2012, 37(5): 746-766.
16. 　何代霞, 陳旭平, 蔣志凌. Child-Pugh分級對失代償期肝硬化預后的評估[J]. 華西醫學, 2009, 24(4): 894-896.
17. 　Zardi EM, Uwechie V, Caccavo D, et al. Portosystemic shunts in a large cohort of patients with liver cirrhosis: detection rate and clinical relevance[J]. J Gastroenterol, 2009, 44(1): 76-83.
18. 　吳柳, 范竹萍, 顧海燕, 等. 多層螺旋CT檢查在肝硬化患者食管靜脈曲張診斷和分級中的價值[J]. 胃腸病學, 2009, 14(1): 12-15.

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CT門靜脈血管成像與內鏡診斷胃食管靜脈曲張的比較

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《華西醫學》

CT門靜脈血管成像與內鏡診斷胃食管靜脈曲張的比較

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