Diagnosis of Esophageal and Gastric Varices by CT Portography or Endoscopy_West China Medical Journal

Authors：

CHEN Xuping ¹ ,  JIANG Zhiling ¹ , CHEN Xia ¹ , FU Dan ¹ , LIU Jun. ²

1. Department of Gastroenterology; 2. CT Room; the Sixth People’s Hospital of Chengdu, Chengdu, Sichuan 610051, P. R. China;

Corresponding author：

JIANG Zhiling, Email: cxuping1011@163.com

Keywords：

门静脉高压; 胃食管静脉曲张; 门静脉造影术; 内镜; 体层摄影术，X线计算机

DOI：

10.7507/1002-0179.20130076

Video：

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目的　比较CT门静脉血管成像（CTP）与内镜诊断肝硬化胃食管静脉曲张的效果，探讨CTP对肝硬化门静脉高压侧支循环血管的显示及其在随访中的价值。方法　对2010年1月－2011年12月收治的43例肝硬化患者行多排螺旋CT增强扫描门静脉血管成像，观察胃食管静脉曲张程度，及有无其他侧支开放，并在4周内行内镜检查，了解胃食管静脉曲张的程度。结果　43例患者中有33例经胃镜确诊食管静脉曲张，其中CTP诊断与胃镜相符29例；胃镜诊断胃底静脉曲张14例，其中有12例CTP诊断与之相符；CTP诊断胃食管静脉曲张与内镜有较好的相关性和一致性，但在判断食管静脉曲张部位上与胃镜一致性较差。结论　对肝硬化患者可采用CTP进行随访，以评估胃食管静脉曲张出血风险，可减少不必要的内镜随访。

Citation： CHEN Xuping,JIANG Zhiling,CHEN Xia,FU Dan,LIU Jun.. Diagnosis of Esophageal and Gastric Varices by CT Portography or Endoscopy. West China Medical Journal, 2013, 28(2): 240-243. doi: 10.7507/1002-0179.20130076 Copy

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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, 宁刚, 等. 多排螺旋CT血管成像技术对肝硬化门脉高压侧支循环血管的评价[J]. 放射学实践, 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, 陈旭平, 蒋志凌. Child-Pugh分级对失代偿期肝硬化预后的评估[J]. 华西医学, 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.	吴柳, 范竹萍, 顾海燕, 等. 多层螺旋CT检查在肝硬化患者食管静脉曲张诊断和分级中的价值[J]. 胃肠病学, 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. 　中华医学会消化内镜分会.食管胃静脉曲张内镜下诊断和治疗规范[J]. 中华消化内镜杂志, 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 ﬁrst 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. 　中华医学会. 食管胃静脉曲张出血的诊治建议(草案)[J].中华内科杂志, 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, 吴云林, 王蕾, 等. 多层螺旋CT门静脉血管成像与内镜对食管、胃静脉曲张诊断的比较研究[J]. 中华消化杂志, 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, 宁刚, 等. 多排螺旋CT血管成像技术对肝硬化门脉高压侧支循环血管的评价[J]. 放射学实践, 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, 陈旭平, 蒋志凌. Child-Pugh分级对失代偿期肝硬化预后的评估[J]. 华西医学, 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. 　吴柳, 范竹萍, 顾海燕, 等. 多层螺旋CT检查在肝硬化患者食管静脉曲张诊断和分级中的价值[J]. 胃肠病学, 2009, 14(1): 12-15.

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Diagnosis of Esophageal and Gastric Varices by CT Portography or Endoscopy

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