肝硬化患者食管曲张静脉出血的预测

食管、胃底曲张静脉形成是门脉系高压的结局,但是导致食管曲张静脉破裂出血的因素相当复杂。根据Laplace定律,T=TP·(r/w),食管曲张静脉(EV)出血的危险性与曲张静脉壁张力(T)平行,与穿壁性压力(tp)和曲张静脉的半径(r)呈正比,与曲张静脉壁厚度(W)呈反比,其出血     

心得安对食管曲张静脉套扎后再出血的影响

目的:观察心得安对食管曲张静脉套扎后再出血的影响.方法:7 8 例门脉高压性食管静脉曲张(esophageal varices, EV)患者, 分成单独套扎组(39例, 作为对照组)和心得安组(39例, 套扎后给予心得安, 10 mg, 3次/d, po). 比较两组套扎后12 mo内再出血率, 同时12 mo后复查胃镜,比较两组患者门脉高压性胃病及胃底曲张静脉发生率.结果:套扎12 mo后再出血率心得安组明显低于对照组(38.70% vs 54.54%, P<0.05). 心得安组门脉高压性胃病发生率、胃底静脉发生率,食管静脉再发率均明显低于对照组(32.25% vs57.57%, 25.80% vs 42.42%, 29.03% vs 39.39%,均P<0.05).结论:心得安可降低食管曲张静脉套扎后再出血, 其原因是心得安能够降低套扎后的门脉高压性胃病和食管、胃底静脉曲张的发生.     

肝硬化时食管、胃在内镜下的特征

食管、胃内镜的特征性表现,尤其是食管曲张静脉(EV)的大小及EV复盖粘膜的红变征被认为是肝硬化病人胃肠道出血的预测性因素。晚近,胃粘膜的花斑样改变或充血性胃病被认为与门脉高压有关。本研究     

门脉高压食管曲张静脉出血的高危性评估

食管曲张静脉破裂出血是门脉高压的主要死因，建立有效的预测食管静脉出血方法有助于克服门脉高压选择手术适应证的盲目性。本就门脉高压食管静脉出血高危性评估的现状作一综述。     

门脉高压食管曲张静脉出血的高危性评估

食管曲张静脉破裂出血是门脉高压的主要死因,建立有效的预测食管静脉出血方法有助于克服门脉高压选择手术适应证的盲目性。本文就门脉高压食管静脉出血高危性评估的现状作一综述。     

门静脉高压脾切除门奇静脉离断术后再出血的食管胃静脉曲张分类研究

目的：探讨门静脉（门脉）高压患者脾切除门奇静脉离断术（脾切断流术）后再发上消化道出血的平均时间、内镜下食管和胃静脉曲张的分类特点及门脉高压性胃病的发病率。方法：190例肝硬化门脉高压出血患者分为脾切断流术后再出血组（40例）和未行手术组（150例）,统计手术患者术后至首次出血的平均时间间隔,每组患者分别行内镜检查,观察并对比其曲张静脉的分型特点及门脉高压性胃病发生率。结果：脾切断流术后再发出血时间平均为24个月,再出血患者内镜皆提示存有食管和（或）胃静脉曲张,2组患者内镜下的曲张静脉分型构成比有明显差异,脾切断流术者以单纯食管静脉曲张及食管胃静脉曲张（GOV）1型为主,未发现孤立性胃静脉曲张（IGV）1型及IGV2型,60．0％患者存在门脉高压性胃病,其发病率及严重程度均高于未行手术组患者。结论：脾切断流术治疗门脉高压近期止血疗效确切,但术后曲张静脉并未有效消退,须强调手术的规范性,并在再出血高发时段定期内镜随访．及时掌握食管胃曲张静脉及门脉高压性胃病的发展情况,早期干预治疗,从而改善患者预后。     

降门脉压各种药物的临床疗效和评价

门脉高压症常并发胃底食管静脉曲张,由于覆盖静脉的食管粘膜薄受胸腔负压的影响胃酸返流的损伤以及粗糙食物的摩擦等常致曲张静脉破裂出血。据报道门脉高压症患者,其门脉压力梯度(门脉压——下腔静脉压)<1.6kpa(12mmHg时,很少发生曲张静脉破裂出血(Schmid)门脉高压是门脉系统血流增加及阻力升高的结果,门脉血流与心输出量和进入门脉系统血量的多少有关;门脉阻力则与血液粘度,血管长度成正比,而与血管半径成反比。在肝硬化患者主要由于肝内门脉系统血管半径缩小,肝血窦收缩变窄。防治曲张静脉破裂出血的关键是降低门静脉的压力过去曾做门腔静脉吻合手术以减低门脉压力,可预防曲张静脉破裂出血。最     

用细针穿刺测定肝硬化患者食管曲张静脉压及其与食管镜下表现和肝病严重性的关系

曲张静脉表面呈樱桃红色或积血色斑(红色征)是门脉高压患者食管曲张静脉出血的危险因素。有认为这种内窥镜下的征象可反映组织学上的上皮内血管充血扩张。本文测定肝硬化食管曲张静脉的跨壁压(TOVP),并研究 TOVP 与各种临床、实验室和内镜参数的关系。方法 40例有中度或重度(直径>2mm)食管曲张的肝硬化患者,于第一次硬化疗法前,在内镜下直接测定 TOVP。全部病例均未服过出血预防药,亦未用过曲张静脉或门脉的降压药。全部腹水患者及12/29例无腹水患者正在接受利尿药治疗。测压前记录有无     

肝硬化并发上消化道出血的药物治疗

肝硬化并发上消化道出血的药物治疗湖北省荆门市血吸虫病防治所（４４８０００）刘章龙肝硬化并发上消化道出血的主要原因，是门脉高压导致食管胃底曲张静脉的破裂出血，以及由门脉高压导致的胃粘膜病变出血（即非曲张静脉破裂出血）。后者主要包括消化性溃疡、胃粘膜糜烂...     

门脉高压食管静脉曲张粘膜糜烂出血

门脉高压食管静脉曲张出血是上消化道出血的重要原因。目前对门脉高压食管静脉曲张出血的诊断及急诊治疗多着重于曲张静脉破裂出血，作者提出对门脉高压性食管粘膜糜烂引起的出血应引起重视。     

Endoprosthetics for bleeding esophageal varices

Refractory esophageal hemorrhage and early rebleeding following endoscopic therapy remain challenging conditions to treat and are associated with a high mortality. Techniques such as balloon tamponade (BT) and transjugular intrahepatic portosystemic shunt (TIPS) are highly effective at controlling refractory bleeding, but they can be associated with a high rate of complications and, in the case of TIPS, may not be immediately available outside specialist centers. Recently, removable self-expanding metal stents (SEMSs) have been introduced in clinical practice for the management of esophageal variceal bleeding. SEMSs control bleeding by tamponade of varices in the distal esophagus and can remain in situ for a number of days, thus preventing early rebleeding. The use of SEMSs does not require the transfer of the patient to a specialist center, and unlike TIPS, it is not associated with deterioration in liver function. The use of SEMSs has been described in small series of patients with refractory bleeding. These series report high rates of hemostasis with low complication rates, suggesting that SEMSs may have an important role in the management of refractory bleeding either as an alternative to BT or where TIPS is contraindicated. SEMSs may also have a role in treating complications of therapy for bleeding esophageal varices, such as postbanding ulceration and BT-induced esophageal tears. The aim of this review is to summarize the published data on the efficacy of SEMSs and suggest future studies that may clarify its role in the management of esophageal variceal hemorrhage.     

Endoscopic management of esophageal varices

The rupture of gastric varices results in variceal hemorrhage, which is one the most lethal complications of cirrhosis. Endoscopic therapies for varices aim to reduce variceal wall tension by obliteration of the varix. The two principal methods available for esophageal varices are endoscopic sclerotherapy (EST) and band ligation (EBL). The advantages of EST are that it is cheap and easy to use, and the injection catheter fits through the working channel of a diagnostic gastroscope. Endoscopic variceal ligation obliterates varices by causing mechanical strangulation with rubber bands. The following review aims to describe the utility of EBL and EST in different situations, such as acute bleeding, primary and secondary prophylaxis     

Comparison of esophageal capsule endoscopy and esophagogastroduodenoscopy for diagnosis of esophageal varices

AIM： To investigate the utility of esophageal capsule endoscopy in the diagnosis and grading of esophageal varices.
METHODS： Cirrhotic patients who were undergoing esophagogastroduodenoscopy （EGD） for variceal screening or surveillance underwent capsule endoscopy. Two separate blinded investigators read each capsule endoscopy for the following results： variceal grade, need for treatment with variceal banding or prophylaxis with beta-blocker therapy, degree of portal hypertensive gastropathy, and gastric varices.
RESULTS： Fifty patients underwent both capsule and EGD. Forty-eight patients had both procedures on the same day, and 2 patients had capsule endoscopy within 72 h of EGD. The accuracy of capsule endoscopy to decide on the need for prophylaxis was 74%, with sensitivity of 63% and specificity of 82%. Interrater agreement was moderate （kappa = 0.56）. Agreement between EGD and capsule endoscopy on grade of varices was 0.53 （moderate）. Inter-rater reliability was good （kappa = 0.77）. In diagnosis of portal hypertensive gastropathy, accuracy was 57%, with sensitivity of 96% and specificity of 17%. Two patients had gastric varices seen on EGD, one of which was seen on capsule endoscopy. There were no complications from capsule endoscopy.
CONCLUSION： We conclude that capsule endoscopy has a limited role in deciding which patients would benefit from EGD with banding or beta-blocker therapy. More data is needed to assess accuracy for staging esophageal varices, PHG, and the detection of gastric varices.     

肝硬化门静脉高压合并食管静脉曲张出血的风险评估

食管静脉曲张破裂出血是肝硬化门静脉高压常见及最严重的并发症之一,常危及患者的生命。据报道,每年约7%的肝硬化患者发生食管静脉曲张破裂出血。因此,评估食管静脉曲张出血风险对于临床防治具有重要意义。目前,内镜、一些血清标志物、影像学检查及肝静脉压力梯度(HVPG)等对曲张静脉出血风险的预测具有一定价值。本文将对预测肝硬化门静脉高压所致食管静脉曲张出血风险研究进展作一概述。     

Role of serotonin in development of esophageal and gastric fundal varices

AIM:To determine the effect of free serotonin concentrations in plasma on development of esophageal and gastric fundal varices. METHODS:This prospective study included 33 patients with liver cirrhosis and 24 healthy controls. Ultrasonography and measurement of serotonin concentration in plasma were carried out in both groups of subjects. The upper fiber panendoscopy was performed only in patients with liver cirrhosis. RESULTS:The mean plasma free serotonin levels were much higher in liver cirrhosis patients than in healthy controls (219.0 ± 24.2 nmol/L vs 65.4 ± 18.7 nmol/L,P < 0.0001). There was no significant correlation be-tween serotonin concentration in plasma and the size of the esophageal varices according to Spearman coefficient of correlation (rs =-0.217,P > 0.05). However,the correlation of plasma serotonin concentration and gastric fundal varices was highly significant (rs =-0.601,P < 0.01). CONCLUSION:Free serotonin is significant in pathogenesis of portal hypertension especially in development of fundal varices,indicating the clinical value of serotonergic receptor blockers in these patients.     

部分脾栓塞缓解门脉高压脾亢及胃底食管静脉曲张

目的 探讨部分脾动脉栓塞对缓解门脉高压并脾亢及胃底食管静脉曲张的临床疗效。方法 采用Seldinger技术经股动脉穿刺插管，超选择性脾动脉栓塞治疗肝硬化门脉高压并脾亢及胃底食管静脉曲张46例。观察治疗前后门脉压力，血液白细胞、血小板计数，肝功能及胃底食管静脉曲张的变化情况，判断其治疗效果。结果 栓塞范围为40％～90％，术后患者门脉压力明显降低，肝功能GPT下降，外周血象明显改善，血液白细胞和血小板计数升高，胃底食管静脉曲张得到缓解，上消化道再出血间期延长。无严重的并发症发生。结论 部分脾栓塞治疗肝硬化门脉高压并脾功能亢进是一种安全、有效的方法。既可以降低门脉压力，又可以减轻脾功能亢进，缓解胃底食管静脉曲张。     

Non-invasive response prediction in prophylactic carvedilol therapy for cirrhotic patients with esophageal varices

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经皮肝穿食管曲张静脉栓塞术和脾栓塞的临床应用

目的 联合应用经皮肝穿食管曲张静脉栓塞术（ＰＴＯ）和部分性脾栓塞术（ＰＳＥ）、探讨其对预防和治疗胃底和食管曲张静脉破裂出血合并脾功能亢进的治疗效果。方法 对１３例肝硬化门脉高压口才行ＰＴＯ治疗,然后进行ＰＳＥ《结果 全部病例术后造影及胃镜复查食管静脉曲张明显缓解或消失,未见再出血者。超声复查,脾脏栓塞面积达５０￣６０％,１￣３个月后患者周围血象不同程度回升。结论 ＰＴＯ加ＰＳＥ是治疗食管静脉曲张破     

胃静脉曲张:临床及内镜特征初探

目的 初步观察胃静脉曲张的临床及内镜特征。方法 回顾分析10年来我院资料完整的胃静脉曲张（GV）85例,并与同期仅有食管静脉曲张（EV）196例对照。结果 GV的检出率占同期静脉曲张的30．2％,其中胃食管静脉曲张I型（GOV－1）占74．1％,GOV－Ⅱ型占22．4％,单纯胃静脉曲张I型（IGV－I）占2．4％,IGV－Ⅱ型占1．2％。GOV型GV的病因以肝硬化门脉高压最多见,IGV型GV主要见于非肝硬化节段性门脉高压;GV的各型的检出率与肝功能Child分级无关,GV合并门脉高压性胃病（PHC）发生率高于EV（P＜0．01）。GOV－Ⅱ较GOV－I合并PHG的检出率高、程度重,GOV－Ⅱ较GOV－I合并EV的程度重;而GV的出血率显著低于EV（P＜0．01）。结论 Sarin分类法简单、实用,适合国内推广应用。GV并非少见,检出率占全部静脉曲张的30．2％,其中,GOV－I最多见,GOV－Ⅱ次之,IGV较少,而GV出血较EV少见。     

门脉高压症导致的异位静脉曲张

静脉曲张发生在食管胃结合部以外，称之为异位或迷走静脉曲张，其发生率约30％。这些异位静脉曲张主要位于消化道，在腹膜后、腹壁、胆道、阴道及膀胱处也有报道，发生率较低。异位曲张静脉破裂导致的出血占门脉高压性出血的5％左右，是引起消化道出血的少见原因，报道的多为个案病例，目前经验有限。