Portal venous thrombosis or sclerosis in liver transplantation candidates: Preoperative CT findings and correlation with surgical procedure
Portal venous thrombosis or sclerosis in liver transplantation candidates: Preoperative CT findings and correlation with surgical procedure
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DOI：
10.1148/radiology.220.2.r01au23321
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发表时间：
2001-08-01
期刊：
影响因子：
19.7
通讯作者：
Geller, DA
中科院分区：
文献类型：
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作者：
Brancatelli, G;Federle, MP;Geller, DA
目得：回顾性分析经手术证实的门静脉（PV）血栓形成或硬化患者的CT表现，并将这些表现与原位肝移植（奥尔特）的外科手术相关联。材料和方法：在379例OLT中，39例（10.3%）患者在手术中发现了PV血栓形成或硬化。在奥尔特之前，回顾性分析了35例具有可用CI研究的患者的手术记录和CT图像。评价肝外肺静脉直径和肺静脉系统通畅性。记录了海绵样变、静脉壁钙化或血栓、提示肿瘤的病变、肠系膜静脉曲张、水肿或脾肾分流。采用非配对t检验和Fisher精确检验对结果进行分析。结果：35例患者中，23例（66%）采用直接PV-PV吻合术进行血栓切除术，12例（34%）放置静脉移植物或其他血管病变。肝外PV为8.2 mm，但脾肾分流患者的PV显著降低（P <0.05）。在30例患者中，CT显示血栓形成、PV钙化或其他异常。分别有21例（60%）和11例（31%）患者的血栓延伸至脾静脉和上级肠系膜静脉汇合处或超出汇合处。11例患者（31%）出现肺静脉海绵样变性; 8例（23%）出现索状硬化性肺静脉; 19例（54%）出现脾肾分流; 11例（31%）出现肺静脉钙化; 17例（49%）出现肠系膜水肿; 14例（40%）出现肠系膜静脉曲张。一个cordlike或钙化的PV患者显着（P小于或等于0.05）更有可能需要修改的手术technique.CONCLUSION：奥尔特前，CT可以帮助评估PV和相关的发现和手术管理。
PURPOSE: To review computed tomographic (CT) findings in patients with surgically proved portal venous (PV) thrombosis or sclerosis and to correlate these findings with the surgical procedure used at orthotopic liver transplantation (OLT).MATERIALS AND METHODS: Among 379 OLTs, PV thrombosis or sclerosis was found at surgery in 39 patients (10.3%). Before OLT, surgical records and CT images were retrospectively reviewed in 35 patients with available Ci studies. Diameter of the extrahepatic PV and patency of the PV system were evaluated. Cavernous transformation, calcifications of the venous wail or thrombus, lesions suggestive of tumor, mesenteric varices, edema, or splenorenal shunt were recorded. A nonpaired Student t test and the Fisher exact test were used to analyze the results.RESULTS: Of 35 patients, 23 (66%) underwent thrombectomy with direct PV-to-PV anastomosis and 12 (34%) had placement of venous grafts or other anastomoses. The extrahepatic PV was 8.2 mm, but it significantly (P less than or equal to .05) decreased in patients with splenorenal shunt. In 30 patients, CT depicted thrombosis, PV calcification, or other abnormalities. The thrombus extended to or beyond the confluence of the splenic and superior mesenteric veins in 21 (60%) and 11 (31%) patients, respectively. Eleven patients (31%) had cavernous transformation of the PV; eight (23%), a cordlike sclerotic PV; 19 (54%), a splenorenal shunt; 11 (31%), PV calcification; 17 (49%), mesenteric edema; 14 (40%), mesenteric varices. Patients with a cordlike or calcified PV were significantly (P less than or equal to .05) more likely to require modification of the surgical technique.CONCLUSION: Before OLT, CT can aid in assessment of PV and associated findings and in surgical management.