胰源性门静脉系节段性阻塞MSCT诊断及临床意义.doc

胰源性门静脉系节段性阻塞MSCT诊断及临床意义 　【摘要】 目的 探讨多层螺旋CT(MSCT) 对胰源性门静脉系节段性阻塞的CT诊断及临床意义。 方法 回顾性收集行 MSCT胰腺常规增强扫描、并门静脉血管成像（MSCTP）显示胰腺疾病伴有门静脉系节段性阻塞的32例患者。结果 显示孤立性脾静脉阻塞23例,其中脾静脉全段闭塞17例，节段狭窄、中断闭塞5例, 脾静脉血栓1例。非孤立性脾静脉阻塞9例，其中PV—SV—SMV汇合部中断闭塞6例，近汇合部PV主干合并SMV狭窄、闭塞3例；伴有增粗扭曲的侧支循环静脉30例，合并区域性门静脉高压6例。 结论 MSCTP可更直观的显示：胰腺病变对门静脉系血管的侵犯所致节段性阻塞的特征性表现，可为临床和外科手术治疗方案的制定提供更多的信息。 【关键词】 胰腺疾病 门静脉系阻塞 多层螺旋CT 血管成像 　　【Abstract】 Objective To study the diagnostic evaluation and clinical significance of multislice spiral CT(MSCT) in demonstrating segmental occlusion of portal system caused by pancreatic diseases. Methods Multislice spiral CT portography(MSCTP) was performed in 32 patients who had been confirmed with pancreatic disease and segmental occlusion in portal vein system. Results 23 cases had isolated splenic vein occlusion, including 17 cases with entiely splenic vein thrombosis and 5 cases with segmental stenosis or occlusion thrombosis and 1 case with pancreatic vein thrombus. 9 cases had non-isolated splenic vein occlusion, including 6 cases with interruptive thrombosis in PV-SV-SMV junction and 3 cases with stenosis or occlusion near PV trunk and SMV. 30 cases had been combined with twist vein collateral circulation and 6 cases with portal hypertension. Conclusions MSCTP can demonstrate the characteristic of segmental occlusion in portal vein system caused by pancreatic disease, and can provide rich and accurate information for operation. 　　【Key words】 Pancreatic disease Occlusion of portal system MSCT Angiography 　　 　　胰腺肿瘤或炎性病变的浸润，或压迫致门静脉主干及其属支节段性狭窄中断或闭塞，称为胰源性门静脉系节段性阻塞。作者收集胰腺疾病伴有门静脉系受累节段性阻塞的患者32例，探讨多层螺旋CT对胰源性门静脉系节段性阻塞的CT诊断及临床意义，现报告如下。 　　1 资料与方法 　　1.1 一般资料 　　2004年2月至2007年11月本院 胰腺疾病伴有门静脉系受累患者的32例中胰腺癌28例，其中胰头或头颈部癌11例，胰腺体尾部癌15例，胰腺体尾部癌并滞留假性囊肿1例，胰腺囊腺癌1例。急性胰腺炎2例，慢性胰腺炎假性囊肿2例。28例胰腺癌中伴肝脏单个或多个结节转移19例。男24例，女8例；年龄19～84岁，平均63.2岁。均经B超、CT、手术病理检查及临床综合确诊，其中4例胰腺癌经手术证实，28例经临床随访确诊。 　　1.2 方法 　　使用Philips MX8000 Quad四层螺旋CT机。扫描条件：120KV、250MA、层厚3.2mm、pH 0.875～1。选用非离子型对比剂优维显300mgI/ml，总量90ml，速率3ml/s。经外周静脉用LF高压注射器注入。扫描期相延迟时间点动脉期注