左侧门静脉高压症的多层螺旋CT表现与临床特征

摘要

目的 探讨脾静脉阻塞所致左侧门静脉高压症的多层螺旋CT表现及其临床特征.方法 收集经临床或手术诊断的左侧门静脉高压症23例,所有病例均行多层螺旋CT 3期增强扫描,15例同时行胃周静脉三维成像.着重分析其临床特征和螺旋CT表现.CT片由两位医生评阅,主要观察脾静脉是否阻塞及其阻塞原因、胃周静脉曲张情况、脾脏大小.8例同期行胃镜检查.结果 23例中,上腹疼痛20例,黄疸6例,体重减轻7例,呕血、黑便4例,上腹部肿块13例.8例行胃镜检查者,孤立性胃底静脉曲张5例,食管胃底静脉中度曲张1例.CT显示脾静脉闭塞14例,脾静脉受压明显变窄9例;脾脏增大19例(82 6%),胃网膜静脉曲张23例(100%),胃短静脉曲张15例(65%),胃冠状静脉曲张13例(56.5%).结论 左侧门静脉高压症的临床症状常为原发病症状所掩盖,少数可发生上消化道出血.CT表现主要有脾静脉阻塞或受压、胃周静脉曲张和脾大,其中胃网膜静脉曲张最常见.%Objective To analyze the multi - slice CT appearances and clinical features of left - sided portal hypertension( LPH) .Methods Multi - slice CT images of 23 cases with LPH were reviewed, and especially perigastric collateral ehannels, splenic veins and spleen size were evaluated. Eight cases underwent endoscopy examination. Results The main clinical findings were epigastric pain in 20 cases ,jaundice in 6 , weight loss in 7 , splenomegaly in 19 , hematemesis or melena in 4 and abdominal masses in 13. Among 8 cases with endoscopy examination,5 showed isolated gastric varices,3 showed both gastric and esophageal varices. Enhanced CT demonstrated splenic venous occlusion or stricture in 23 , splenomegaly in 19, as well as enlarged and tortuous gastroepiploic veins in 23 , short gastric veins in 15 , and gastric coronary veins in 13. Conclusion The clinical symptoms of LPH are usually associated with primary diseases. The majar CT findings include splenic venous occlusion or stricture, perigastric collateral veins and splenomegaly.