ABSTRACT
Objective To discuss the application of the degree of portal systemic shunting in assessing the upper gastrointes-tinal bleeding in patients with hepatic schistosomiasis. Methods Thirty - three patients with upper gastrointestinal bleeding caused by hepatic schistosomiasis(a bleeding group)and 29 schistosomiasis cirrhosis patients without bleeding(a non-bleeding group)were enrolled as investigation subjects in Jinshan Hospital. The subjects were scanned by the 128 abdominal slice spiral CT. The portal systemic shunting vessels were reconstructed by using thin slab maximum intensity projection(TSMIP)and multi-planar reconstruction(MPR). The degrees of the shunting vessels of the subjects were evaluated and compared,and the relation-ship between upper gastrointestinal bleeding and the degree of the shunting was analyzed. Results In the bleeding group,the occurrence rates of the shunting vessels were found as follows:86.4% in left gastric varices,68.2% in short gastric varices, 50.0% in esophageal varices,50.0% in para-esophageal varices,37.9% in gastric varices,69.7% in gastric-renal varices, 51.5% in spleen-renal varices,25.8% in abdominal wall varices,15.2% in omentum varices,63.6% in para-splenic varices, 34.8% in umbilical varices,40.9% in retroperitoneal-paravertebral varices,and 36.4% in mesenteric varices. In the bleeding group,the occurrence rates and the degree of shunt were significantly higher than those in the non-bleeding group in esophageal varices,esophageal vein,left gastric vein and gastric varices(all P < 0.05). Conclusions CT portal vein reconstruction can accurately display the location,degree and walking of all kinds of shunting vessels. Esophageal varices,esophageal vein,left gastric vein and gastric varices can accurately predict the risk of upper gastrointestinal bleeding in patients with hepatic schisto-somiasis. The patents with higher degree of the shunting vessels have a higher risk of gastrointestinal bleeding.
ABSTRACT
Objective To evaluate the application value of percutaneous transsplenic varices embolization(PTSVE)in the treatment of upper gastrointestinal hemorrhage in patients with schistosomiasis cirrhosis. Methods Sixteen schistosomiasis cir-rhosis patients(12 males and 4 females)with portal hypertension complicated with esophageal and upper gastrointestinal hemor-rhage were selected as the investigation subjects,all the patients had been treated by esophageal vein ligation and sclerothera-py,but with bleeding again post-operation. The patients were treated by PTSVE under the guidance of X-ray fluoroscopy. The success rate of PTSVE and the rate of complications were observed. In addition,the patients received PTSVE were reexamined with abdominal CT one month post-operation,and the degrees of varices were compared before and after PTSVE. Results Four-teen cases(87.50%)were successfully treated with PTSVE. Two cases(12.50%)failed,and one case had an abdominal bleed-ing 1 week post-operation. The abdominal CT showed the degrees of esophageal varices(P < 0.001),esophageal vein(P <0.001)and gastric varices(P < 0.001)were significantly decreased in the patients who received PTSVE one month after the op-eration. Conclusions PTSVE is a safe and effective method in the treatment of upper gastrointestinal hemorrhage in the pa-tients with schistosomiasis cirrhosis. PTSVE is especially suitable for the patients with severe liver cirrhosis,significantly bor-dered liver split,and bared main portal vein and even the branches.
ABSTRACT
2 mg/dl);the others were in the low-risk group.High-risk patients received more superselective embolization with lower dose of embolization agent and fewer numbers of procedure(1.4 vs 2.3,P