Application of degree of portal systemic shunting in assessing upper gastro-intestinal bleeding in patients with schistosomiasis cirrhosis / 中国血吸虫病防治杂志

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 follows86.4% 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.