门静脉病变的多排螺旋CT检查特征与诊断
문정맥병변적다배라선CT검사특정여진단
Characteristics and diagnosis of multi-slice computed tomography examination of portal vein diseases
  • 万方数据
    中华消化外科杂志 중화소화외과잡지
    Chinese Journal of Digestive Surgery
    2015年 9期 766-770 ,共5页

    任小军%潘高争%王霞%杨如武

    임소군%반고쟁%왕하%양여무

    门静脉病变%肝硬化%静脉曲张%体层摄影术,X线计算机 門靜脈病變%肝硬化%靜脈麯張%體層攝影術,X線計算機
    문정맥병변%간경화%정맥곡장%체층섭영술,X선계산궤
    Portal vein lesions%Liver cirrhosis%Varicose veins%Tomography,X-ray computed
    目的 总结门静脉病变的多排螺旋CT检查特征,以及门静脉原发病变与继发病变的CT检查诊断.方法 回顾性分析2012年1月至2015年3月西安西电集团医院收治的62例、陕西省核工业二一五医院收治的28例、西安高新医院收治的16例门静脉病变患者的影像学检查资料.采用多排螺旋CT检查进行平扫及增强扫描,记录门静脉病变的多排螺旋CT检查表现、其原发病变和继发病变.结果 门静脉宽度改变:106例患者中,门静脉主干管腔增宽45例,主干或分支狭窄39例,闭塞49例(其中伴主干部分增宽21例,伴宽度正常6例).增宽门静脉管腔直径为1.4～2.2 cm,平均1.8 cm;因癌栓形成导致门静脉管腔狭窄或闭塞,出现门静脉直径明显增宽,宽度为1.8 ～4.0 cm,平均2.3 cm.门静脉瘘和积气:肝动脉-门静脉瘘12例,门静脉右后支-下腔静脉瘘2例,下腔静脉-门静脉瘘及门静脉-肝静脉瘘2例,门静脉积气2例.门静脉闭塞病变位置:门静脉闭塞仅位于门静脉主干4例,位于门静脉左、右分支34例,门静脉主干及分支均有闭塞11例.门静脉恶性狭窄和闭塞分别为29例、42例,良性狭窄和闭塞分别为10例、7例.门静脉增宽原发病:43例肝硬化,2例布-加综合征下腔静脉-门静脉-肝静脉瘘.门静脉良性狭窄和闭塞原发病:肝硬化门静脉血栓、巨大海绵状血管瘤、多囊肝及肝脓肿压迫、肝脓肿导致门静脉炎及真性红细胞增多症致门静脉血栓.肝动脉-门静脉瘘、门静脉-下腔静脉瘘原发病:肝癌、肝硬化,下腔静脉-门静脉瘘及门静脉-肝静脉瘘的原发病均为布-加综合征.门静脉积气原发病:肠系膜上动脉栓塞后肠梗死和急性胃扩张.58例患者形成门腔静脉侧支循环(部分患者合并多个部位的静脉曲张或分流);44例患者形成腹腔积液;12例形成门静脉海绵样变;5例形成肠壁缺血水肿;19例患者伴发肝内胆管扩张,其中恶性肿瘤引起胆管梗阻17例,肝硬化门静脉海绵样变伴肝内胆管扩张(门静脉高压性胆管病)2例.结论 门静脉病变多排螺旋CT检查主要表现为门静脉狭窄、闭塞或扩张、积气,其继发病变表现为门-腔静脉侧支循环形成及门静脉海绵样变、肠缺血以及门静脉高压性胆病;其原发病变多样,以肝硬化和恶性肿瘤为主.多排螺旋CT检查可清楚显示门静脉病变,对其原发病变与继发病变可进行准确诊断.
    목적 총결문정맥병변적다배라선CT검사특정,이급문정맥원발병변여계발병변적CT검사진단.방법 회고성분석2012년1월지2015년3월서안서전집단의원수치적62례、합서성핵공업이일오의원수치적28례、서안고신의원수치적16례문정맥병변환자적영상학검사자료.채용다배라선CT검사진행평소급증강소묘,기록문정맥병변적다배라선CT검사표현、기원발병변화계발병변.결과 문정맥관도개변:106례환자중,문정맥주간관강증관45례,주간혹분지협착39례,폐새49례(기중반주간부분증관21례,반관도정상6례).증관문정맥관강직경위1.4～2.2 cm,평균1.8 cm;인암전형성도치문정맥관강협착혹폐새,출현문정맥직경명현증관,관도위1.8 ～4.0 cm,평균2.3 cm.문정맥루화적기:간동맥-문정맥루12례,문정맥우후지-하강정맥루2례,하강정맥-문정맥루급문정맥-간정맥루2례,문정맥적기2례.문정맥폐새병변위치:문정맥폐새부위우문정맥주간4례,위우문정맥좌、우분지34례,문정맥주간급분지균유폐새11례.문정맥악성협착화폐새분별위29례、42례,량성협착화폐새분별위10례、7례.문정맥증관원발병:43례간경화,2례포-가종합정하강정맥-문정맥-간정맥루.문정맥량성협착화폐새원발병:간경화문정맥혈전、거대해면상혈관류、다낭간급간농종압박、간농종도치문정맥염급진성홍세포증다증치문정맥혈전.간동맥-문정맥루、문정맥-하강정맥루원발병:간암、간경화,하강정맥-문정맥루급문정맥-간정맥루적원발병균위포-가종합정.문정맥적기원발병:장계막상동맥전새후장경사화급성위확장.58례환자형성문강정맥측지순배(부분환자합병다개부위적정맥곡장혹분류);44례환자형성복강적액;12례형성문정맥해면양변;5례형성장벽결혈수종;19례환자반발간내담관확장,기중악성종류인기담관경조17례,간경화문정맥해면양변반간내담관확장(문정맥고압성담관병)2례.결론 문정맥병변다배라선CT검사주요표현위문정맥협착、폐새혹확장、적기,기계발병변표현위문-강정맥측지순배형성급문정맥해면양변、장결혈이급문정맥고압성담병;기원발병변다양,이간경화화악성종류위주.다배라선CT검사가청초현시문정맥병변,대기원발병변여계발병변가진행준학진단.
    Objective To summarize the characteristics of multi-slice computed tomography (MSCT) of portal vein diseases and investigate the CT diagnosis of its primary and secondary diseases.Methods The imaging data of 62 patients from Xi'an Xidian Group Hospital,28 patients from Nuclear Industry 215 Hospital of Shanxi Province and 16 patients from Xi'an Gaoxin Hospital with portal vein diseases from January 2012 to March 2015 were retrospectively analyzed.The CT findings,primary and secondary diseases of portal vein lesions were recorded through plain scan and enhanced scan of MSCT.Results Changes in the width of portal vein:among 106 patients,dilation of main portal vein was detected in 45 cases,stenosis of stem or branches of portal vein in 39 cases,portal vein obstruction in 49 cases (21 patients accompanied with enlargement in stem of portal vein and 6 patients with normal width).The diameters of dilated portal vein were 1.4-2.2 cm with a mean diameter of 1.8 cm.The diameters of portal vein with stenosis and occlusion caused by carcinomas were 1.8-4.0 cm with a mean diameter of 2.3cm.Portal vein fistula and pneumatosis:hepatic artery-portal vein fistulas were detected in 12 patients,posterior right branches of portal vein-inferior vena cava fistulas in 2 patients,inferior vena cavaportal vein fistulas and portal-hepatic vein fistulas in 2 patients,pneumatosis in 2 patients.Lesions of portal vein occlusions:occlusions located at main portal veins were detected in 4 cases,left and right branches in 34 cases,both main portal veins and left or right branches in 11 cases.Malignant stenosis and occlusion were detected in 29 and 42 cases,benign stenosis and occlusion were detected in 10 and 7 cases,respectively.Protopathies of portal vein dilation:there were 43 patients with liver cirrhosis and 2 patients with inferior vena cava-portal vein-hepatic vein fistula of Budd-Chiari syndrome.Protopathies of benign stenosis and occlusion:portal vein thrombosis in liver cirrhosis,giant cavernous haemangioma,polycystic disease of liver,pylephlebitis caused by liver abscess,portal vein thrombosis caused by polycythemia vera.Protopathies of hepatic artery portal vein fistula and portal veininferior vena cava fistula:liver cancer and liver cirrhosis,protopathy of inferior vena cava-portal vein fistula and portal vein-hepatic vein fistula were Budd-Chiari syndrome.Protopathies of pneumatosis:intestinal infarction after superior mesenteric artery embolus and acute gastric dilatation.Portacaval collateral circulation occurred in 58 patients (partial patients complicated with multi-point varices and shunts),ascites in 44 patients,portal vein cavernous transformation in 12 patients,ischemia and edema of intestinal wall in 5 patients,intrahepatic cholangiectasis in 19 patients including 17 cases of biliary obstruction caused by malignant tumors and 2 cases of portal vein cavernous transformation complicated with intrahepatic cholangiectasis (portal hypertensive biliopathy).Conclusions The MSCT for portal vein diseases is presented as portal vein stenosis,occlusion or dilation,pneumatosis.Secondary lesions are portacaval collateral circulation,portal vein cavernous transformation,intestinal ischemia and portal hypertensive biliopathy,and primary lesions are mainly liver cirrhosis and malignant tumors.MSCT can show clearly the portal vein lesions and diagnose accurately its primary and secondary lesions.
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