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目的通过64排螺旋CT门静脉血管造影评估82例门静脉海绵样变患儿的影像表现并探讨其临床价值。方法选择82例经手术证实门静脉海绵样变患儿,其中男性48例,女性34例;年龄2个月~15岁,平均年龄4.7岁。首次行64排螺旋CT门静脉造影,分析各病例合并症情况、门静脉海绵样变范围及门静脉主干和各属支管径宽度。结果按门静脉变性累及范围将82例分为3型,Ⅰ型为门静脉主干及分支海绵样变性型26例,Ⅱ型为门静脉主干远端及分支海绵样变性型47例,Ⅲ型为门静脉左和/或右支海绵样变性型9例。全部病例合并发育畸形比例高达30.5%,合并门静脉栓塞比例为9.8%。Ⅰ型合并症中恶性肿瘤及门静脉栓塞比率相对较高,Ⅲ型病例合并症中各种发育畸形比例相对较高。各型间门静脉属支管径比较,胃冠状静脉宽径组间差异有统计学意义(P<0.05)。Ⅰ型病例胃冠状静脉较宽。结论小儿门静脉海绵样变主要是先天性发育畸形导致的。影像表现可分为3型,Ⅰ型更适合Rex手术。
Objective To evaluate the imaging findings and explore the clinical value of 82 cases of portal-type cavernous changes in children with 64-slice spiral CT portal venography. Methods Eighty-two cases of portal-cavernous degeneration were confirmed by surgery, including 48 males and 34 females. The age ranged from 2 months to 15 years with a mean age of 4.7 years. For the first time, 64-slice spiral CT portal venography was performed to analyze the complication of each case, the range of sponge-like portal vein and the diameter of the portal vein and the diameter of each branch. Results According to the extent of portal vein degeneration, 82 cases were divided into 3 types, type Ⅰ was portal vein and branch cavernous degeneration in type Ⅰ, type Ⅱ was 47 cases with main portal vein distal and branch cavernous degeneration, type Ⅲ was portal vein left and / Or right cavernous degeneration in 9 cases. All cases combined with malformations as high as 30.5%, combined with portal vein embolization was 9.8%. The rate of malignant tumor and portal vein embolism in type Ⅰ complication is relatively high, and the proportion of various malformations in type Ⅲ complication is relatively high. There was significant difference between the diameters of the branches of the portal vein in each type and in the diameter of the coronary coronary vein (P <0.05). Type Ⅰ cases of gastric coronary vein wide. Conclusion Pediatric portal vein sponge-like changes are mainly caused by congenital malformations. Image performance can be divided into 3 types, type Ⅰ more suitable for Rex surgery.