肝硬变食管下段静脉曲张的CT研究进展
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摘要
目的总结肝硬变门静脉高压食管下段静脉曲张相关的CT研究进展。方法查阅国内外与肝硬变门静脉高压食管静脉曲张有关的CT研究文献,分析总结CT在食管下段静脉曲张诊断、评估等方面的研究现状与进展。结果 CT与内镜诊断食管静脉曲张间有较好的相关性,CT在评估食管静脉曲张有无、程度以及出血风险方面具有重要价值,尤其在预测其出血风险上可作为有效手段,在一定程度上辅助内镜检查。结论 CT是食管静脉曲张的重要检查手段,在诊断与评估方面有重要价值,未来可以开展更深入的研究,进一步为食管静脉曲张的诊治提供更有力和精准的支持。
Objective To summarize the research progress of CT related to esophageal varices of cirrhotic patients complicated with portal hypertension. Methods Relevant CT literatures of esophageal varices of cirrhotic patients complicated with portal hypertension were collected to make an review,then summarized the research status and progress of CT in the diagnosis and evaluation of lower esophageal varices. Result CT had a good correlation with endoscopic diagnosis of esophageal varices, and CT was of great value in evaluating the presence, degree, and risk of esophageal varicose veins, especially in predicting the risk of esophageal varicose veins, which could be used as an effective modality to assist endoscopic examination to a certain extent. Conclusions CT is an important examination method for esophageal varices, which has important value in diagnosis and evaluation. In the future, more further researches can be carried out to provide more strong and accurate support for the diagnosis and treatment of esophageal varices.
Objective To summarize the research progress of CT related to esophageal varices of cirrhotic patients complicated with portal hypertension. Methods Relevant CT literatures of esophageal varices of cirrhotic patients complicated with portal hypertension were collected to make an review,then summarized the research status and progress of CT in the diagnosis and evaluation of lower esophageal varices. Result CT had a good correlation with endoscopic diagnosis of esophageal varices, and CT was of great value in evaluating the presence, degree, and risk of esophageal varicose veins, especially in predicting the risk of esophageal varicose veins, which could be used as an effective modality to assist endoscopic examination to a certain extent. Conclusions CT is an important examination method for esophageal varices, which has important value in diagnosis and evaluation. In the future, more further researches can be carried out to provide more strong and accurate support for the diagnosis and treatment of esophageal varices.
引文
1 Kim YJ,Raman SS,Yu NC,et al.Esophageal varices in cirrhotic patients:evaluation with liver CT.AJR Am J Roentgenol,2007,188(1):139-144.
2 Dessouky BA, Abdel Aal el SM. Multidetector CT oesophagography:an alternative screening method for endoscopic diagnosis of oesophageal varices and bleeding risk.Arab J Gastroenterol,2013,14(3):99-108.
3中华医学会肝病学分会,中华医学会消化病学分会,中华医学会消化内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南.中华内科杂志,2016,55(1):57-72.
4中华医学会消化内镜学分会.食管胃静脉曲张内镜下诊断和治疗规范试行方案(2003年).中华消化内镜杂志,2004,21(3):149-151.
5 Kim H,Choi D,Gwak GY,et al.Evaluation of esophageal varices on liver computed tomography:receiver operating characteristic analyses of the performance of radiologists and endoscopists.J Gastroenterol Hepatol,2009,24(9):1534-1540.
6 Sarin SK,Wadhawan M,Agarwal SR,et al.Endoscopic variceal ligation plus propranolol versus endoscopic variceal ligation alone in primary prophylaxis of variceal bleeding.Am J Gastroenterol,2005,100(4):797-804.
7何欣,黄仲奎,龙莉玲,等.比较多层螺旋CT门静脉成像与内镜检查诊断肝硬化合并食管胃静脉曲张的优劣.中华放射学杂志,2012,46(12):1092-1095.
8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.中华消化杂志,2007,27(2):78-82.
9陈旭平,蒋志凌,陈霞,等.CT门静脉血管成像与内镜诊断胃食管静脉曲张的比较.华西医学,2013,28(2):240-243.
10刘桂勤,华静,沈加林.CT门静脉血管成像预测肝硬化门静脉高压食管胃底静脉曲张破裂出血价值.中华实用诊断与治疗杂志,2015,29(4):396-398.
11 Kim SH,Kim YJ,Lee JM,et al. Esophageal varices in patients with cirrhosis:multidetector CT esophagography-comparison with endoscopy.Radiology,2007,242(3):759-768.
12翟红军.螺旋CT门静脉造影成像与胃镜对肝硬化、食管胃底静脉曲张对比的价值探讨.按摩与康复医学:下旬刊,2012,3(8):15-16.
13蒋志凌,陈旭平,付冰,等.肝硬化食管静脉曲张程度门脾静脉内径及Child-Pugh分级的关系·华西医学,2011,26(2):187-188.
14 de Franchis R,Baveno VI Faculty.Expanding consensus in portal hypertension:report of the Baveno VI Consensus Workshop:stratifying risk and individualizing care for portal hypertension.J Hepatol,2015,63(3):743-752.
15 Garcia-Tsao G,Groszmann RJ,Fisher RL,et al.Portal pressure,presence of gastroesophageal varices and variceal bleeding.Hepatology,1985,5(3):419-424.
16 Polio J, Groszmann RJ, Reuben A,et al. Portal hypertension ameliorates arterial hypertension in spontaneously hypertensive rats.J Hepatol,1989,8(3):294-301.
17秦将均,涂蓉,巫北海,等.胃左静脉的多层螺旋CT评价对预测食管静脉曲张出血风险的价值.实用放射学杂志,2011,27(9):1366-1369.
18宋兵,李彩英,刘增品,等.胃左静脉MSCTA预测肝硬化门静脉高压食管胃底静脉曲张破裂出血的价值.临床放射学杂志,2011,30(7):979-983.
19梁晓春,王维,王小宜,等.CT预测肝硬化门静脉高压并发上消化道出血风险的ROC分析.临床放射学杂志,2006,25(5):434-438.
20张鑫,孙浩,许金卫.肝硬化门脉高压患者食管静脉曲张CT表现预测首次上消化道出血的风险.中华临床医师杂志:电子版,2013,7(16):122-123.
21 Mifune H,Akaki S,Ida K,et al.Evaluation of esophageal varices by multidetector-row CT:correlation with endoscopic'red color sign'.Acta Med Okayama,2007,61(5):247-254.
22 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.N Engl J Med,1988,319(15):983-989.
23 Miller L,Banson FL,Bazir K,et al. Risk of esophageal variceal bleeding based on endoscopic ultrasound evaluation of the sum of esophageal variceal cross-sectional surface area. Am J Gastroenterol,2003,98(2):454-459.
24 Rice JP,Lubner M,Taylor A,et al. CT portography with gastric variceal volume measurements in the evaluation of endoscopic therapeutic efficacy of tissue adhesive injection into gastric varices:a pilot study.Dig Dis Sci,2011,56(8):2466-2472.
25何欣,黄仲奎,龙莉玲,等.肝硬化并食管静脉曲张多层螺旋CT门静脉成像的临床应用.实用放射学杂志,2012,28(11):1707-1711.
26 Hino S,Kakutani H,Ikeda K,et al. Hemodynamic analysis of esophageal varices using color Doppler endoscopic ultrasonography to predict recurrence after endoscopic treatment.Endoscopy,2001,33(10):869-872.
27谭友文,於学军,殷玉梅.肝硬化门静脉高压门脉血流动力学检测及其临床意义.中华超声影像学杂志,2001,10(3):151-153.
28郝婷婷,马晓鹏,戴光荣,等.肝硬化门静脉高压患者食管静脉曲张CT表现预测首次上消化道出血的价值.胃肠病学和肝病学杂志,2017,26(1):29-31.
29余杨红,丁山,邓克学.多层螺旋CT门静脉成像对食管胃底静脉曲张出血的评价.安徽医科大学学报,2013,48(11):1376-1379.
30栾立,段红霞,刘严明,等.CT测量脾脏指数预判肝硬化食管静脉曲张及出血的可能.实用放射学杂志,2006,22(4):421-423.
31 Calame P,Ronot M,Bouveresse S,et al. Predictive value of CT for first esophageal variceal bleeding in patients with cirrhosis:value of para-umbilical vein patency.Eur J Radiol,2017,87:45-52.
32 Yang CT,Chen HL,Ho MC,et al. Computed tomography indices and criteria for the prediction of esophageal variceal bleeding in survivors of biliary atresia awaiting liver transplantation.Asian J Surg,2011,34(4):168-174.
33刘成环,任明思,李俊华,等.肝硬化门静脉高压患者脐静脉开放的CT诊断价值.青海医药杂志,2010,40(6):57-59.
34楮倩,李震,张苏明,等.肝性脑病与门静脉高压侧枝循环形成的关系——CT门静脉造影的监测价值.中国医学影像学杂志,2004,12(1):1-3.
35雷钊.食管旁静脉与食管静脉曲张的相关性.中国普通外科杂志,2012,21(12):1571-1573.
36 Kodama H,Aikata H,Takaki S,et al.Evaluation of portosystemic collaterals by MDCT-MPR imaging for management of hemorrhagic esophageal varices.Eur J Radiol,2010,76(2):239-245.
37 Merli M,Nicolini G,Angeloni S,et al. Incidence and natural history of small esophageal varices in cirrhotic patients.J Hepatol,2003,38(3):266-272.
38李伟.多层螺旋CT门静脉成像评估肝硬化食管静脉曲张出血风险.胃肠病学和肝病学杂志,2013,22(12):1262-1266.
39 Lin XZ,Miao F,Li JY,et al. High-definition CT Gemstone spectral imaging of the brain:initial results of selecting optimal monochromatic image for beam-hardening artifacts and image noise reduction.J Comput Assist Tomogr,2011,35(2):294-297.
40 Lv P, Lin XZ, Li J, et al. Differentiation of small hepatic hemangioma from small hepatocellular carcinoma:recently introduced spectral CT method.Radiology,2011,259(3):720-729.
41赵丽琴,贺文,李剑颖,等.应用能谱CT研究肝硬化门静脉高压患者肝血流动力学变化.中华放射学杂志,2011,45(8):782-783.
42王芳,沈加林,华静,等.能谱CT评估肝硬化食管静脉曲张程度的价值研究.临床放射学杂志,2016,35(2):208-212.
43张军,邓克学.能谱CT预测肝硬化门静脉高压患者并发食管静脉曲张破裂出血风险.中国医学影像技术,2012,28(12);2201-2205.
44王道庆,刘玉丽.多层螺旋CT检查辐射危害控制探讨.中国辐射卫生,2016,25(5):569-572.
45李殊吏,李青,张翼,等.1200例肿瘤患者CT检查辐射剂量的调查研究.国际肿瘤学杂志,2014,41(4):302-305.
2 Dessouky BA, Abdel Aal el SM. Multidetector CT oesophagography:an alternative screening method for endoscopic diagnosis of oesophageal varices and bleeding risk.Arab J Gastroenterol,2013,14(3):99-108.
3中华医学会肝病学分会,中华医学会消化病学分会,中华医学会消化内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南.中华内科杂志,2016,55(1):57-72.
4中华医学会消化内镜学分会.食管胃静脉曲张内镜下诊断和治疗规范试行方案(2003年).中华消化内镜杂志,2004,21(3):149-151.
5 Kim H,Choi D,Gwak GY,et al.Evaluation of esophageal varices on liver computed tomography:receiver operating characteristic analyses of the performance of radiologists and endoscopists.J Gastroenterol Hepatol,2009,24(9):1534-1540.
6 Sarin SK,Wadhawan M,Agarwal SR,et al.Endoscopic variceal ligation plus propranolol versus endoscopic variceal ligation alone in primary prophylaxis of variceal bleeding.Am J Gastroenterol,2005,100(4):797-804.
7何欣,黄仲奎,龙莉玲,等.比较多层螺旋CT门静脉成像与内镜检查诊断肝硬化合并食管胃静脉曲张的优劣.中华放射学杂志,2012,46(12):1092-1095.
8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.中华消化杂志,2007,27(2):78-82.
9陈旭平,蒋志凌,陈霞,等.CT门静脉血管成像与内镜诊断胃食管静脉曲张的比较.华西医学,2013,28(2):240-243.
10刘桂勤,华静,沈加林.CT门静脉血管成像预测肝硬化门静脉高压食管胃底静脉曲张破裂出血价值.中华实用诊断与治疗杂志,2015,29(4):396-398.
11 Kim SH,Kim YJ,Lee JM,et al. Esophageal varices in patients with cirrhosis:multidetector CT esophagography-comparison with endoscopy.Radiology,2007,242(3):759-768.
12翟红军.螺旋CT门静脉造影成像与胃镜对肝硬化、食管胃底静脉曲张对比的价值探讨.按摩与康复医学:下旬刊,2012,3(8):15-16.
13蒋志凌,陈旭平,付冰,等.肝硬化食管静脉曲张程度门脾静脉内径及Child-Pugh分级的关系·华西医学,2011,26(2):187-188.
14 de Franchis R,Baveno VI Faculty.Expanding consensus in portal hypertension:report of the Baveno VI Consensus Workshop:stratifying risk and individualizing care for portal hypertension.J Hepatol,2015,63(3):743-752.
15 Garcia-Tsao G,Groszmann RJ,Fisher RL,et al.Portal pressure,presence of gastroesophageal varices and variceal bleeding.Hepatology,1985,5(3):419-424.
16 Polio J, Groszmann RJ, Reuben A,et al. Portal hypertension ameliorates arterial hypertension in spontaneously hypertensive rats.J Hepatol,1989,8(3):294-301.
17秦将均,涂蓉,巫北海,等.胃左静脉的多层螺旋CT评价对预测食管静脉曲张出血风险的价值.实用放射学杂志,2011,27(9):1366-1369.
18宋兵,李彩英,刘增品,等.胃左静脉MSCTA预测肝硬化门静脉高压食管胃底静脉曲张破裂出血的价值.临床放射学杂志,2011,30(7):979-983.
19梁晓春,王维,王小宜,等.CT预测肝硬化门静脉高压并发上消化道出血风险的ROC分析.临床放射学杂志,2006,25(5):434-438.
20张鑫,孙浩,许金卫.肝硬化门脉高压患者食管静脉曲张CT表现预测首次上消化道出血的风险.中华临床医师杂志:电子版,2013,7(16):122-123.
21 Mifune H,Akaki S,Ida K,et al.Evaluation of esophageal varices by multidetector-row CT:correlation with endoscopic'red color sign'.Acta Med Okayama,2007,61(5):247-254.
22 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.N Engl J Med,1988,319(15):983-989.
23 Miller L,Banson FL,Bazir K,et al. Risk of esophageal variceal bleeding based on endoscopic ultrasound evaluation of the sum of esophageal variceal cross-sectional surface area. Am J Gastroenterol,2003,98(2):454-459.
24 Rice JP,Lubner M,Taylor A,et al. CT portography with gastric variceal volume measurements in the evaluation of endoscopic therapeutic efficacy of tissue adhesive injection into gastric varices:a pilot study.Dig Dis Sci,2011,56(8):2466-2472.
25何欣,黄仲奎,龙莉玲,等.肝硬化并食管静脉曲张多层螺旋CT门静脉成像的临床应用.实用放射学杂志,2012,28(11):1707-1711.
26 Hino S,Kakutani H,Ikeda K,et al. Hemodynamic analysis of esophageal varices using color Doppler endoscopic ultrasonography to predict recurrence after endoscopic treatment.Endoscopy,2001,33(10):869-872.
27谭友文,於学军,殷玉梅.肝硬化门静脉高压门脉血流动力学检测及其临床意义.中华超声影像学杂志,2001,10(3):151-153.
28郝婷婷,马晓鹏,戴光荣,等.肝硬化门静脉高压患者食管静脉曲张CT表现预测首次上消化道出血的价值.胃肠病学和肝病学杂志,2017,26(1):29-31.
29余杨红,丁山,邓克学.多层螺旋CT门静脉成像对食管胃底静脉曲张出血的评价.安徽医科大学学报,2013,48(11):1376-1379.
30栾立,段红霞,刘严明,等.CT测量脾脏指数预判肝硬化食管静脉曲张及出血的可能.实用放射学杂志,2006,22(4):421-423.
31 Calame P,Ronot M,Bouveresse S,et al. Predictive value of CT for first esophageal variceal bleeding in patients with cirrhosis:value of para-umbilical vein patency.Eur J Radiol,2017,87:45-52.
32 Yang CT,Chen HL,Ho MC,et al. Computed tomography indices and criteria for the prediction of esophageal variceal bleeding in survivors of biliary atresia awaiting liver transplantation.Asian J Surg,2011,34(4):168-174.
33刘成环,任明思,李俊华,等.肝硬化门静脉高压患者脐静脉开放的CT诊断价值.青海医药杂志,2010,40(6):57-59.
34楮倩,李震,张苏明,等.肝性脑病与门静脉高压侧枝循环形成的关系——CT门静脉造影的监测价值.中国医学影像学杂志,2004,12(1):1-3.
35雷钊.食管旁静脉与食管静脉曲张的相关性.中国普通外科杂志,2012,21(12):1571-1573.
36 Kodama H,Aikata H,Takaki S,et al.Evaluation of portosystemic collaterals by MDCT-MPR imaging for management of hemorrhagic esophageal varices.Eur J Radiol,2010,76(2):239-245.
37 Merli M,Nicolini G,Angeloni S,et al. Incidence and natural history of small esophageal varices in cirrhotic patients.J Hepatol,2003,38(3):266-272.
38李伟.多层螺旋CT门静脉成像评估肝硬化食管静脉曲张出血风险.胃肠病学和肝病学杂志,2013,22(12):1262-1266.
39 Lin XZ,Miao F,Li JY,et al. High-definition CT Gemstone spectral imaging of the brain:initial results of selecting optimal monochromatic image for beam-hardening artifacts and image noise reduction.J Comput Assist Tomogr,2011,35(2):294-297.
40 Lv P, Lin XZ, Li J, et al. Differentiation of small hepatic hemangioma from small hepatocellular carcinoma:recently introduced spectral CT method.Radiology,2011,259(3):720-729.
41赵丽琴,贺文,李剑颖,等.应用能谱CT研究肝硬化门静脉高压患者肝血流动力学变化.中华放射学杂志,2011,45(8):782-783.
42王芳,沈加林,华静,等.能谱CT评估肝硬化食管静脉曲张程度的价值研究.临床放射学杂志,2016,35(2):208-212.
43张军,邓克学.能谱CT预测肝硬化门静脉高压患者并发食管静脉曲张破裂出血风险.中国医学影像技术,2012,28(12);2201-2205.
44王道庆,刘玉丽.多层螺旋CT检查辐射危害控制探讨.中国辐射卫生,2016,25(5):569-572.
45李殊吏,李青,张翼,等.1200例肿瘤患者CT检查辐射剂量的调查研究.国际肿瘤学杂志,2014,41(4):302-305.