| Background80-90% of decompensated liver cirrhosis can be combined with varices.At present,one of the first-line treatment for the gastric varices is tissue glue injection by electronic gastroscope.However,there is no clear requirement on how to choose the injection site.In the past when the tissue glue was injected,the more severe varices and more obvious uplift in the varices were often selected,but the amount of tissue glue was also increased accordingly,and the bleeding may occur after needle removal.Furthermore,with regard to how to clear the amount of tissue glue during treatment,in addition to the rough estimation of the amount by endoscopy,the volume of gastric varices can be calculated by the three-dimensional reconstruction of MSCT to assess the amount of tissue glue in theory,But there are fewer reports about this.And for the follow-up method in postoperative patients,use gastroscope more often,but it is invasive,some patients can not be tolerated,and MSCT can also be used for follow-up,but now mainly rely on the measurement of the portal vein system collateral vein diameter size to assess the risk of rebleeding,this approach is more tedious,and can seek more simple indicators of rebleeding further.Objective1.To analyze the inflow and outflow of gastric varices in cirrhosis patients using multi-slice spiral CT(MSCT);2.to evaluate the relationship between the CT volumetry of gastric varices and the dose of tissue glue.3.to evaluate the effect of unoccluded vascular shadow in the area surrounding the previous tissue glue injection in MSCT during follow-up.Methodspatients of cirrhosis with the gastric varices were recruited from November 2013 to August 2017.The type and route of varices were assessed before tissue glue injection treatment by MSCT.The relationship between the CT volumetry of gastric varices and the dose of tissue was analyzed by Spearman rank correlation coefficient and unary linear regression analysis.for some postoperative patients,follow-up was performed with MSCT to analyze the effect of unoccluded vascular shadow in the area surrounding the previous tissue glue injection in the rebleeding of gastric varices.ResultsLe,g type ranked the highest proportion of gastric varices in patients(54.6%),followed by Le,g,Lg type(20.6%).Le,Lg type and Lgf type each accounted for 17.5%,5.2%.Lgf+b type is only 2.1%.Gastric varices were shaped from bottom to top,some of them have gastrorenal shunt(75%)under the gastroscope,the small curvature of the stomach shaped form the near to the distant,the large curvature of the stomach can be found the near to the distant or from far to near blood flow direction due to the different viewing angles when the mirror body is reversed.The median volume of the CT volumetry of gastric varices was 3.48(IQR 2.20-4.90)cm3,and the median dose of the tissue glue was 2.5(IQR 1.5-4.5)ml.Both results of the Spearman rank correlation coefficient(r = 0.97,P < 0.001)and linear regression analysis(P < 0.001)showed significant positive correlation between the CT volumetry of gastric varices and the dose of tissue glue.during follow-up,if MSCT examination revealed the presence of unoccluded vascular shadow in the area surrounding the previous tissue glue injection.after being treated with tissue glue,the disappearance of vassel was observed in the follow-up of MSCT.no rebleeding occurred.ConclusionThe inflow and outflow of gastric varices in cirrhosis patients can be identified by MSCT.The CT volumetry of gastric varices and the dose of tissue glue was significant positive correlated,which showed that MSCT is an useful tool to predict the dose of tissue glue before tissue glue treatment.for patients with tissue glue injection,it is necessary to follow-up by MSCT for six months after the injection.If there is an existing unoccluded vascular shadow in the area surrounding the previous tissue glue injection of MSCT,it indicates that there is a possibility of bleeding.At this time,it is recommended to organize tissue glue treatment again. |
