| Objective: Using3D contrast-en-hanced MR angiography （3D CE-MRI）toillustrate the morphological changes of portal venous system、collateral vessel bloodflow, and its spatial anatomic relationship with surrounding organs.To research thediagnosis of3D CE-MRA for the portal vein and its main collateral circulationsituation with portal hypertension, and discuss the guiding role on drawing up thesurgical strategies of3D CE-MRA which research flow dynamics about portal veinand its collateral; To summarize the preliminary experience of the resection of severeadhesive megalosplenia and reserve vena gastrica posterior communicating branch inselective pericardial devascularization （improved selective pericardialdevascularization）.Materials and Methods: Chose98patients who were diagnosed as portalhypertension and were admitted to PLA General Hospital from July,2007to October,2011. All of them were treated with the operations named splenectomy+improvedselective pericardial devascularization. All of them successfully received3DCE-MRA examinations, the images reconstructed were analyzed to study the vaule ofCE-MRA in illustrate the lesions of portal system and the existent of collateralcirculation，and the guidance about selective pericardial devascularization.Results: All of the98patients were received CE-MRA successfully,98cases ofwhich illustrate the main portal vein clearly, visualization ratio was100%.94casesillustrated stomach coronary vein varices; short gastric vein varices52cases;esophageal varices89cases; stomach/spleen-renal shunt23cases. The results ofCE-MRA and gastroscope in dignosing esophageal varices were highly interrelated,0.40<κ=0.42<0.75. The exploratory laparotomys were unanimous with CE-MRAimages.98cases were cured, and no operative mortality and serious complicationssuch as stomach or colon perforation.81cases recovered smoothly.17casesdeveloped a common complication or complications after surgery, the incidence was 17.35%. The measurement results of portal vein diameter perioperatively werecompared by statistics and showed significant differences. It indicates splenectomy+improved selective pericardial devascularization has significantly effect in thetreatment of portal hypertension.98cases were followed up for3months to3years.Except one case had a small amount of black stools, the others had no re-bleeding, therate was only1.02%, The liver function of all patients also improved significantly.Conclusions:(1) CE-MRA could comprehensively illustrate the diameter、runningand other leisions of portal vein and collateral vessel. By the analysis of imaging dataWe could sufficiently understand the surgical focus and difficulty in preoperative, andso could institute surgical strategies and steps. It avoids blind separation andexploration during operation, minimizes damage and shorts the operative time.Meanwhile, greatly improves the safety and effectiveness of the surgery.(2) CE-MRAwas a noninvasive examination which could illustrate the level and range ofesophagous varices. The results were highly accordant with gastroscope, which coulduse to seek for the existent of esophagous varices and help to prevent massivehemorrhage of gastrointestinal tract.(3) The careful evaluation before operation,standardized operative procedure, reasonable and effective dissection of perisplenicadhesion and the splenic peduncular cut with minute bleeding, are the keymanagements to ensure the success of splenectomy in patients with severe adhesivemegalosplenia. Especially using ultrasonic knife and disposable stapler rationally andeffectively, the surgery of severe adhesions splenectomy is safe and feasible.(5) Theimproved selective pericardial devascularization avoids the shortage of simple methodsuch as disconnection or shunt operation, and the operation is easier. The operativetime is saved, the effect is satisfactory and the probability of complication andre-bleeding after surgery is decreased. Meanwhile, this method ensures portal veineffective blood supply，which will help the recovery of liver function, it is worthfurther study. |
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