Applied Research Of CT Angiography In The Treatment Of Portal Hypertension

Objective:Retrospect 58 patients with portal hypertension by CT angiography (CTA),analysis the applications of CTA in the treatment of portal hypertension.Methods:Analyse 58 patients diagnosed with portal hypertension form June 2008 to April 2009 in the Third Xiangya Hospital.20 patients underwent medical treatment(medical group).18 patients underwent Endoscopic variceal ligation(EVL group),9 patients underwent Hassab's Procedure (devascularization group),and 11 patients underwent Hassab's Procedure combined with Endoscopic variceal ligation(combined group).we try to discuss the applications of CT angiography(CTA) and the three dimensional reconstruction of the portal vein-related vessels in clinic treatment.Results:There are no significant differences between these four groups in sex, age,history of upper gastrointestinal hemorrhage,etiology and Child-Pugh classification before CT examination.After CT examination,the CTA shows the portal collateral circulation of these 58 patients well.There are no significant statistical differences(P＞0.05) between these four groups of patients in portal vein,splenic vein and superior mesenteric vein;The portal vein and splenic vein diameter have correlation coefficient of r=0.690,p=0.002;The portal vein and superior mesenteric vein diameter have correlation coefficient of r=0.497,p=0.027;splenic vein and superior mesenteric vein diameter have correlation coefficient of r=0.366,p=0.101. Patients with stomach-renal shunt and splenorenal shunt have significant lower portal vein,splenic vein and superior mesenteric vein diameter than that of patients without shunt(P＜0.05),but patients with stomach-renal shunt or splenorenal shunt has no significant differences(P＞0.05) in these aspects.Medical group and EVL group has no significant differences (P＞0.05) in the diameter of left gastric vein.EVL group and the combination group have significant lower diameter of veins of submucosal esophageal than the devascularization group and medical group(P＜0.05),while the EVL group and combination group, devascularization group and medical group have no significant differences(P＞0.05);Devascularization group and combination group have significant small veins around the esophageal than EVL group and medical group(P＜0.05),while there are no differences between EVL group and combination group or EVL group and medical group(P＞0.05); There are no significant differences of azygos vein diameter in these four groups(P＞0.05).There are significant differences between medical group and EVL group,medical group and devascularization group,medical group and combined group,EVL group and combined group, devascularization group and combined group in the volume of esophageal veins of lower 5cm.but it shows no differences between EVL group and devascularization group.Conclusion:First,CT angiography can clearly display the changes in portal-related vessels,the main branches and collateral circulation of the portal system.Second,we can measure the vessels' diameter accurately with it.Third,it is useful for clinical diagnosis,the assessment of illness, individualized therapy,evaluating the efficacy of surgery and its prognosis,it has wide range of clinical applications.Forth,the combination of EVL and Hassab's procedure can better meliorate the degree of esophageal varices than themselves alone and medical treatment.It should be wildly promoted.