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門靜脈高壓的側枝循環－電腦斷層攝影所見
Venous Collateral in Portal Hypertension Demostarted by CT Scan
摘要
以電腦斷層攝影(CT)檢查高血壓門靜脈的側枝循環以經胃冠狀靜脈側枝發現率最高，達54.2%，其中91.4%病人伴隨食道靜脈曲張。34.5%食道靜脈曲張病例出現食道周圍靜脈曲張，可作為食道靜脈曲張的佐證。CT對胃靜脈曲張沒有很好的判讀標準，較良好的胃部準備可能改善此一情況。經肝側枝發現率7.5%；6名臨床上有明顯的肝性腦病變病患一半可發現此側枝存在。經膈側枝除肋膜心包膜／腹膜的側枝循環網可自CT顯示外，尚發現橫膈膜前方自外下向內上側走向的側枝，這條途徑在下腔靜脈阻塞時更益明顯。向後至腹膜後腔的側枝循環可如食道周圍靜脈一種出現巨大的團塊。86.9%側枝循環發生在包括冠狀靜脈，脾腎及／或胰十二指腸在內的左腹側枝，深具重要性。向上及向下後的側枝循環以冠狀靜脈為例，兩者並無互相抵消的現象。向前的側枝－臍周圍靜脈並不是很重要的側枝循環單獨發生的機會只有2.8%。同時發現向上向前向後的機會是13.1%。13例門靜脈阻塞病例都產生海綿狀轉化，可在肝門附近或膽囊窩處發現側枝循環。有無門靜脈阻塞的門一體靜脈循環和腹水、脾腫的發生率並無統計學上的差異。
並列摘要
Computed tomography (CT) is one of the non-invasive modality for investigating the collateral circulation of portal hypertension. The most frequent collateral circulation is coronary-gastroesophageal collateral (54.2%) and the incidence is 91.4% when accompanied by esophageal varices. This indicate that esophageal endoscopic examination is needed when CT only demonstrated the presence of gastroesophageal collaterals. Periesophageal varices are noted in 34.5% of patients with esophageal varices, their presence may help to identify esophageal varices. The indentification of gastric varices is not clear-cut and better preparation of the stomach may be helpful. Trans-hepatic collateral is noted in 7.5%, three of six patients with hepatic encephalopathy has this collateral. Trans-diaphragmatic collateral include pleuropericardial/peritoneal network and furthermore, there is another collateral coming from the exterior-inferior of the diaphragm to the interior-superior, which is more conspicuous during occlusion of the inferior vena cava. Those retroperitoneal collateral circulation can resenable those periesophageal varices as lobulated masses. The left flank collateral circulation is quite important since 86.9% occurs there including the coronary vein, splenorenal and/or pancreaticoduodenal vein. The collaterals draining upward and those going inferior posterior (eg coronary vein) do not affect each other. The anterior collateral-paraumbilical vein is not an important collateral and it occurs solitarily in 2.8% of cases. Simulataneous collateral going upward, anteriorly and posteriorly occured in about 13.1% of cases. Thirteen patients with portal vein thrombosis have caverous transformation and collaterals can be noted in the portal hepatis and gall bladder fossa areas. The relationship of porto-systemic venous collateral, ascites, splenomegaly, with portal venous thrombosis has no statistic significance.