Comparison of collateral circulation opening status in hepatic and pancreatogenic portal hypertension_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Guangwen ¹ , LIU Xijiao ² ,  SONG Bin ²

1. Department of Radiology, Sichuan Academy of Medical Sciences, Sichuan Provincial People’s Hospital, Chengdu 610072, P. R. China;
2. Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

SONG Bin, Email: cjr.songbin@vip.163.com

Keywords：

portal hypertension; collateral circulation; computed tomography portography

DOI：

10.7507/1007-9424.201803024

Video：

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Objective The purpose of this study is to compare the differences of opened collateral circulation status between hepatic portal hypertension (HPH) and pancreatogenic portal hypertension (PPH), to guide the clinical treatment. Methods From Nov. 2015 to Oct. 2017, data of 119 cases of computed tomography portography (CTP) from the Department of Radiology of Sichuan Provincial People’s Hospital and Department of Radiology of West China Hospital of Sichuan University were retrospective analyzed, and the patients were divided into 2 groups, namely the HPH group (77 patients) and PPH group (42 patients) according to different causes. The diameter of portal vein system (including trunk of portal vein, left gastric vein, splenic vein, superior mesenteric vein, and gastroepiploic vein) and the incidences of varicose veins (lower esophageal vein, gastric fundal vein, gastric body vein, Retzius vein varix, umbilical vein open, and splenorenal shunt), as well as the degree of varicose of lower esophageal vein, gastric fundal, and gastric body vein were compared. Results The diameter of portal vein in the HPH group was larger than that of the PPH group, but the diameter of gastroepiploic vein was smaller than that of the PPH group, and the differences were statistically significant (P<0.05). There was no significant difference in left gastric vein, splenic vein, and superior mesenteric vein between the 2 groups (P>0.05). Significant differences were found in varicose veins incidence of gastric and lower esophageal vein (P<0.05), the varicose veins incidence of gastric was lower and varicose veins incidence of lower esophageal vein was higher in the HPH group. Statistically significant differences were also found in the incidence of umbilical vein open, Retzius varicose veins and splenorenal shunt between the 2 groups (P<0.05), and the incidences were all higher in the HPH group. Conclusions There are differences in collateral circulation status between the HPH and PPH. Gastric fundal and lower esophageal vein varices are easy to appear simultaneously in HPH, while gastric fundal and body vien varices are mostly only occurred in PPH. Compared with HPH, the degree of gastric fundal and lower esophageal vein varices is more mild in PPH.

Citation： CHEN Guangwen, LIU Xijiao, SONG Bin. Comparison of collateral circulation opening status in hepatic and pancreatogenic portal hypertension. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(5): 622-628. doi: 10.7507/1007-9424.201803024 Copy

1.	Bannas P, Roldán-Alzate A, Johnson KM, et al. Longitudinal Monitoring of Hepatic Blood Flow before and after TIPS by Using 4D-Flow MR Imaging. Radiology, 2016, 281(2): 574-582.
2.	徐小元. 肝硬化食管胃靜脈曲張出血的預防. 中華醫學雜志, 2016, 96(33): 2609-2610.
3.	Zhao Y, Wang C. The therapeutic effect of splenectomy plus selective pericardial devascularization versus conventional pericardial devascularization on portal hypertension in China: a meta-analysis. Oncotarget, 2018, 9(20): 15398-15408.
4.	張忠勝, 趙冬, 王洪峰, 等. 64 層螺旋 CT 門靜脈三維重組對門靜脈高壓側支循環的研究及臨床應用. 醫學影像學雜志, 2010, 20(9): 1328-1330.
5.	韓春宏, 姚偉根, 張建豐, 等. MSCT 門靜脈造影和內鏡對食管靜脈曲張分級的對照研究. 放射學實踐, 2013, 28(2): 177-180.
6.	中華外科學分會門靜脈高壓癥學組. 肝硬化門靜脈高壓癥食管胃底靜脈曲張破裂出血的診治共識(2015版). 中華普通外科雜志, 2016, 31(2): 167-170.
7.	Hejda V. Late complications of liver cirrhosis - management of gastrointestinal bleeding in the presence of portal hypertension. Vnitr Lek, 62(9 Suppl 2): 10-17.
8.	Wang AJ, Li BM, Zheng XL, et al. Utility of endoscopic ultrasound in the diagnosis and management of esophagogastric varices. Endosc Ultrasound, 2016, 5(4): 218-224.
9.	Conejo I, Guardascione MA, Tandon P, et al. Multicenter External Validation of Risk Stratification Criteria for Patients With Variceal Bleeding. Clin Gastroenterol Hepatol, 2018, 16(1): 132-139.
10.	黃金鑫, 周主青, 尤天庚, 等. CT 門靜脈成像的臨床解剖學分析. 中華肝膽外科雜志, 2013, 19(9): 641-644.
11.	中華醫學會肝病學分會中華醫學會消化病學分會中華醫學會消化內鏡學分會. 肝硬化門靜脈高壓食管胃靜脈曲張出血的防治指南. 中華內科雜志, 2016, 55(1): 57-72.
12.	余繼海, 許戈良, 馬金良, 等. CT 門靜脈成像分型個體化手術治療在肝硬化門靜脈高壓癥中的應用價值. 中華肝臟外科手術學電子雜志, 2016, 5(3): 135-140.
13.	吳明蓬, 謝艷, 宋彬, 等. 門靜脈高壓癥患者食管靜脈曲張多層螺旋 CT 與內鏡分級的相關性. 中華消化病與影像雜志(電子版), 2014, 4(3): 108-111.
14.	Tseng Y, Ma L, Luo T, et al. Non-invasive predictive model for hepatic venous pressure gradient based on a 3-dimensional computed tomography volume rendering technology. Exp Ther Med, 2018, 15(4): 3329-3335.
15.	李睿, 陳天武, 李春平. 肝硬化門靜脈高壓的影像學研究新進展. 放射學實踐, 2011, 26(9): 1015-1017.
16.	王家臣, 鞏若箴, 田軍, 等. CT 門靜脈成像對食管胃靜脈曲張側支循環的研究. 醫學影像學雜志, 2010, 20(6): 845-847.
17.	李大勇, 郭應林, 李大慶, 等. 64 層螺旋 CT 門靜脈造影在顯示肝硬化門靜脈高壓側支循環中的價值. 中國醫學影像學雜志, 2010, (04): 343-347.
18.	張嘉瑜, 劉龍平, 王成林. 肝硬化門靜脈高壓側支血管開放的影像學特征及臨床意義. 中國CT和MRI雜志, 2016, 14(1): 77-80, 122.
19.	謝軍, 戈偉, 余德才, 等. 門靜脈高壓癥患者出血風險的影像學評分. 中國普外基礎與臨床雜志, 2017, 24(2): 232-237.
20.	Khanna R, Sarin SK. Idiopathic portal hypertension and extrahepatic portal venous obstruction. Hepatol Int, 2018, 12(Suppl 1): 148-167.
21.	李松蔚, 張捷, 閆東, 等. 多層螺旋 CT 及其門靜脈造影在 TIPS 聯合胃冠狀靜脈栓塞術前應用價值. 介入放射學雜志, 2015, 24(6): 559-563.
22.	程燕, 宋彬. 多排螺旋 D 血管成像技術對肝硬化門脈高壓側支循環血管的顯示價值. 中國醫學影像技術, 2004, 20(9):1390-1393.
23.	張云利, 王兵, 金望迅. 胰體尾腫瘤伴胰源性門靜脈高壓根治性切除的臨床療效. 中華肝膽外科雜志, 2016, 22(5): 329-331.
24.	靳勇, 林曉珠, 吳云林, 等. 多層螺旋 CT 門靜脈血管成像在胰源性門脈高壓癥診斷中的應用. 中華消化雜志, 2008, 28(9): 580-584.
25.	何盟國, 沈乃營, 譚棟, 等. 脾切除賁門周圍血管離斷術對肝硬化門靜脈高壓癥患者肝臟血流動力學及肝功能的影響. 中國普外基礎與臨床雜志, 2016, 23(8): 978-981.

1. Bannas P, Roldán-Alzate A, Johnson KM, et al. Longitudinal Monitoring of Hepatic Blood Flow before and after TIPS by Using 4D-Flow MR Imaging. Radiology, 2016, 281(2): 574-582.
2. 徐小元. 肝硬化食管胃靜脈曲張出血的預防. 中華醫學雜志, 2016, 96(33): 2609-2610.
3. Zhao Y, Wang C. The therapeutic effect of splenectomy plus selective pericardial devascularization versus conventional pericardial devascularization on portal hypertension in China: a meta-analysis. Oncotarget, 2018, 9(20): 15398-15408.
4. 張忠勝, 趙冬, 王洪峰, 等. 64 層螺旋 CT 門靜脈三維重組對門靜脈高壓側支循環的研究及臨床應用. 醫學影像學雜志, 2010, 20(9): 1328-1330.
5. 韓春宏, 姚偉根, 張建豐, 等. MSCT 門靜脈造影和內鏡對食管靜脈曲張分級的對照研究. 放射學實踐, 2013, 28(2): 177-180.
6. 中華外科學分會門靜脈高壓癥學組. 肝硬化門靜脈高壓癥食管胃底靜脈曲張破裂出血的診治共識(2015版). 中華普通外科雜志, 2016, 31(2): 167-170.
7. Hejda V. Late complications of liver cirrhosis - management of gastrointestinal bleeding in the presence of portal hypertension. Vnitr Lek, 62(9 Suppl 2): 10-17.
8. Wang AJ, Li BM, Zheng XL, et al. Utility of endoscopic ultrasound in the diagnosis and management of esophagogastric varices. Endosc Ultrasound, 2016, 5(4): 218-224.
9. Conejo I, Guardascione MA, Tandon P, et al. Multicenter External Validation of Risk Stratification Criteria for Patients With Variceal Bleeding. Clin Gastroenterol Hepatol, 2018, 16(1): 132-139.
10. 黃金鑫, 周主青, 尤天庚, 等. CT 門靜脈成像的臨床解剖學分析. 中華肝膽外科雜志, 2013, 19(9): 641-644.
11. 中華醫學會肝病學分會中華醫學會消化病學分會中華醫學會消化內鏡學分會. 肝硬化門靜脈高壓食管胃靜脈曲張出血的防治指南. 中華內科雜志, 2016, 55(1): 57-72.
12. 余繼海, 許戈良, 馬金良, 等. CT 門靜脈成像分型個體化手術治療在肝硬化門靜脈高壓癥中的應用價值. 中華肝臟外科手術學電子雜志, 2016, 5(3): 135-140.
13. 吳明蓬, 謝艷, 宋彬, 等. 門靜脈高壓癥患者食管靜脈曲張多層螺旋 CT 與內鏡分級的相關性. 中華消化病與影像雜志(電子版), 2014, 4(3): 108-111.
14. Tseng Y, Ma L, Luo T, et al. Non-invasive predictive model for hepatic venous pressure gradient based on a 3-dimensional computed tomography volume rendering technology. Exp Ther Med, 2018, 15(4): 3329-3335.
15. 李睿, 陳天武, 李春平. 肝硬化門靜脈高壓的影像學研究新進展. 放射學實踐, 2011, 26(9): 1015-1017.
16. 王家臣, 鞏若箴, 田軍, 等. CT 門靜脈成像對食管胃靜脈曲張側支循環的研究. 醫學影像學雜志, 2010, 20(6): 845-847.
17. 李大勇, 郭應林, 李大慶, 等. 64 層螺旋 CT 門靜脈造影在顯示肝硬化門靜脈高壓側支循環中的價值. 中國醫學影像學雜志, 2010, (04): 343-347.
18. 張嘉瑜, 劉龍平, 王成林. 肝硬化門靜脈高壓側支血管開放的影像學特征及臨床意義. 中國CT和MRI雜志, 2016, 14(1): 77-80, 122.
19. 謝軍, 戈偉, 余德才, 等. 門靜脈高壓癥患者出血風險的影像學評分. 中國普外基礎與臨床雜志, 2017, 24(2): 232-237.
20. Khanna R, Sarin SK. Idiopathic portal hypertension and extrahepatic portal venous obstruction. Hepatol Int, 2018, 12(Suppl 1): 148-167.
21. 李松蔚, 張捷, 閆東, 等. 多層螺旋 CT 及其門靜脈造影在 TIPS 聯合胃冠狀靜脈栓塞術前應用價值. 介入放射學雜志, 2015, 24(6): 559-563.
22. 程燕, 宋彬. 多排螺旋 D 血管成像技術對肝硬化門脈高壓側支循環血管的顯示價值. 中國醫學影像技術, 2004, 20(9):1390-1393.
23. 張云利, 王兵, 金望迅. 胰體尾腫瘤伴胰源性門靜脈高壓根治性切除的臨床療效. 中華肝膽外科雜志, 2016, 22(5): 329-331.
24. 靳勇, 林曉珠, 吳云林, 等. 多層螺旋 CT 門靜脈血管成像在胰源性門脈高壓癥診斷中的應用. 中華消化雜志, 2008, 28(9): 580-584.
25. 何盟國, 沈乃營, 譚棟, 等. 脾切除賁門周圍血管離斷術對肝硬化門靜脈高壓癥患者肝臟血流動力學及肝功能的影響. 中國普外基礎與臨床雜志, 2016, 23(8): 978-981.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of collateral circulation opening status in hepatic and pancreatogenic portal hypertension

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