Endoscopic treatment of esophageal varices in patients with liver cirrhosis

Variceal bleeding is a life-threatening complication of portal hypertension with a six-week mortality rate of approximately 20%. Patients with medium- or large-sized varices can be treated for primary prophylaxis of variceal bleeding using two strategies: non-selective beta-blockers(NSBBs) or endoscopic variceal ligation(EVL). Both treatments are equally effective. Patients with acute variceal bleeding are critically ill patients. The available data suggest that vasoactive drugs, com-bined with endoscopic therapy and antibiotics, are the best treatment strategy with EVL being the endoscopic procedure of choice. In cases of uncontrolled bleeding, transjugular intrahepatic portosystemic shunt(TIPS) with polytetrafluoroethylene(PTFE)-covered stents are recommended. Approximately 60% of the patients experience rebleeding, with a mortality rate of 30%. Secondary prophylaxis should start on day six following the initial bleeding episode. The combination of NSBBs and EVL is the recommended management, whereas TIPS with PTFE-covered stents are the preferred op-tion in patients who fail endoscopic and pharmacologic treatment. Apart from injection sclerotherapy and EVL, other endoscopic procedures, including tissue adhe-sives, endoloops, endoscopic clipping and argon plasmacoagulation, have been used in the management of esophageal varices. However, their efficacy and safety, compared to standard endoscopic treatment, remain to be further elucidated. There are safety issues accompa-nying endoscopic techniques with aspiration pneumonia occurring at a rate of approximately 2.5%. In conclu-sion, future research is needed to improve treatment strategies, including novel endoscopic techniques with better efficacy, lower cost, and fewer adverse events.     

血吸虫病肝硬化食管静脉曲张破裂出血的危险因素

目的 目的 探讨血吸虫病肝硬化食管静脉曲张破裂出血的相关危险因素。方法 方法 选择血吸虫病肝硬化食管静脉曲 张破裂出血患者113例为出血组, 血吸虫病肝硬化食管静脉曲张非出血患者128例为对照组, 进行相关因素分析。结果 结果 经比较, 两组凝血酶原时间、 门静脉主干内径、 食管静脉曲张程度、 曲张静脉瘤样病变的差异均有统计学意义 （P均< 0.01）。结论 结论 血吸虫病肝硬化患者发生食管静脉曲张破裂出血的危险因素为凝血酶原时间、 门静脉主干内径、 食管静脉 曲张程度、 曲张静脉瘤样病变。     

Defining the advantages and exposing the limitations of endoscopic variceal ligation in controlling acute bleeding and achieving complete variceal eradication

BACKGROUND Bleeding esophageal varices(BEV) is a potentially life-threatening complication in patients with portal hypertension with mortality rates as high as 25% within six weeks of the index variceal bleed. After control of the initial bleeding episode patients should enter a long-term surveillance program with endoscopic intervention combined with non-selective β-blockers to prevent further bleeding and eradicate EV.AIM To assess the efficacy of endoscopic variceal ligation(EVL) in controlling acute variceal bleeding, preventing variceal recurrence and rebleeding and achieving complete eradication of esophageal varices(EV) in patients who present with BEV.METHODS A prospectively documented single-center database was used to retrospectively identify all patients with BEV who were treated with EVL between 2000 and 2018. Control of acute bleeding, variceal recurrence, rebleeding, eradication and survival were analyzed using Baveno assessment criteria.RESULTS One hundred and forty patients(100 men, 40 women; mean age 50 years; range, 21–84 years; Child-Pugh grade A = 32; B = 48; C = 60) underwent 160 emergency and 298 elective EVL interventions during a total of 928 endoscopy sessions. One hundred and fourteen(81%) of the 140 patients had variceal bleeding that was effectively controlled during the index banding procedure and never bled again from EV, while 26(19%) patients had complicated and refractory variceal bleeding. EVL controlled the acute sentinel variceal bleed during the first endoscopic intervention in 134 of 140 patients(95.7%). Six patients required balloon tamponade for control and 4 other patients rebled in hospital. Overall 5-d endoscopic failure to control variceal bleeding was 7.1%(n = 10) and four patients required a salvage transjugular intrahepatic portosystemic shunt. Index admission mortality was 14.2%(n = 20). EV were completely eradicated in 50 of 111 patients(45%) who survived 3 mo of whom 31 recurred and 3 rebled. Sixteen(13.3%) of 120 surviving patients subsequently had 21 EV rebleeding episodes and 10 patients bled from other sources after discharge from hospital. Overall rebleeding from all sources after 2 years was 21.7%(n = 26). Sixty-nine(49.3%) of the 140 patients died, mainly due to liver failure(n = 46) during follow-up. Cumulative survival for the 140 patients was 71.4% at 1 year, 65% at 3 years, 60% at 5 years and 52.1% at 10 years.CONCLUSION EVL was highly effective in controlling the sentinel variceal bleed with an overall 5-day failure to control bleeding of 7.1%. Although repeated EVL achieved complete variceal eradication in less than half of patients with BEV, of whom 62% recurred, there was a significant reduction in subsequent rebleeding.     

肝硬化食管静脉曲张出血的急诊内镜下套扎治疗

目的 探讨急诊内镜下紧急套扎治疗肝硬化食管静脉曲张(EV)破裂出血的安全性及止血效果。方法 对89例肝硬化EV出血患者在急诊状态下紧急内镜套扎,监测套扎术前、术中及结束时血压、心率、呼吸变化,观察套扎过程对生命体征的影响。结果 急诊止血成功率达98.9％,套扎过程对生命体征无明显影响(P均>0.05),术中无并发症发生。近期再出血2例。肝硬化患者76例随访3-30个月,死亡11例,病死率14.5％。结论 紧急EVL治疗肝硬化EV破裂出血是一种安全、有效、快捷的止血方法。     

经皮脾门静脉核素显像预测肝硬化食管静脉曲张破裂出血的临床研究

为探讨经皮脾门静脉核素显像预测肝硬化食管静脉曲张破裂出血的价值,对40例肝炎后肝硬化和12例非肝病患者（对照组）进行经皮脾门静脉核素显像和胃镜检查。结果显示,根据心-肝曲线特点将肝硬化分为门静脉高压无分流型（Ⅰ型）、有分流型（Ⅱ型）、有侧支循环型（Ⅲ型）及完全肝外分流型（四型）。肝硬化组门体分流指数（PSSI）为0.541±0.128,显著高于对照组0.192±0.086（P＜0.01）;Ⅲ型和Ⅳ型的PSSI显著高于Ⅰ、Ⅱ型（P＜0.01）;F2、3组与F0、1组、红色征（＋）组与红色征（－）组,以及出血组与非出血组之间PSSI均有显著性差异（P＜0.01）,PSSI＞0.62时,食管静脉曲张破裂出血发生率显著增高。提示经皮脾门静脉核素显像可作为预测肝硬化食管静脉曲张破裂出血的重要手段。     

Primary and secondary prophylaxis of esophageal variceal bleeding

Cirrhosis is a chronic condition with high-mortality. Portal hypertension (PH) is the initial and main consequence of cirrhosis and is responsible for most of its complications, including esophageal varices. A portal pressure, as determined by the hepatic venous pressure gradient (HVPG) >5 mm Hg defines PH. When the HVPG reaches 10 mm Hg or greater, the patient with compensated cirrhosis has developed clinically significant PH and is at a higher risk of developing varices and clinical decompensation. Patients with varices that have not bled are still in the compensated stage but are at a higher risk of decompensation than those without varices. Variceal hemorrhage constitutes a decompensating event, but its mortality differs whether it presents as an isolated complication of cirrhosis (20% 5-year mortality) or whether it presents in association with other complications (more than 80% 5-year mortality). While in the past, emphasis had been placed on managing the direct complications of PH, varices and variceal hemorrhage, it is now clear that these complications cannot be considered in an isolated manner. Rather, they should be considered in the context of advances in the staging of cirrhosis and other complications of cirrhosis that might occur concomitant or subsequent to the development of varices and variceal hemorrhage.     

Nonselective beta-blockers in cirrhotic patients with no or small varices:A meta-analysis

AIM:To explore effects of nonselective beta-blockers(NSBBs) in cirrhotic patients with no or small varices.METHODS:The Pub Med,EMBASE,Science Direct,and Cochrane library databases were searched for relevant papers.A meta-analysis was performed using ORs with 95%CI as the effect sizes.Subgroup analysis was conducted according to the studies including patients without varices and those with small varices.RESULTS:Overall,784 papers were initially retrieved from the database searches,of which six randomized controlled trials were included in the meta-analysis.The incidences of large varices development(OR = 1.05,95%CI:0.25-4.36;P = 0.95),first upper gastrointestinal bleeding(OR = 0.59,95%CI:0.24-1.47;P = 0.26),and death(OR = 0.70,95%CI:0.45-1.10;P = 0.12) were similar between NSBB and placebo groups.However,the incidence of adverse events was significantly higher in the NSBB group compared with the placebo group(OR = 3.47,95%CI:1.45-8.33;P = 0.005).The results of subgroup analyses were similar to those of overall analyses.CONCLUSION:The results of this meta-analysis indicate that NSBBs should not be recommended for cirrhotic patients with no or small varices.     

Primary prophylaxis of variceal bleeding in patients with cirrhosis: A comparison of different strategies

Patients with cirrhosis and esophageal varices bleed at a yearly rate of 5%-15%, and, when variceal hemorrhage develops, mortality reaches 20%. Patients are deemed at high risk of bleeding when they present with medium or large-sized varices, when they have red signs on varices of any size and when they are classified as Child-Pugh C and have varices of any size. In order to avoid variceal bleeding and death, individuals with cirrhosis at high risk of bleeding must undergo primary prophylaxis, for which currently recommended strategies are the use of traditional non-selective beta-blockers (NSBBs) (i.e., propranolol or nadolol), carvedilol (a NSBB with additional alpha-adrenergic blocking effect) or endoscopic variceal ligation (EVL). The superiority of one of these alternatives over the others is controversial. While EVL might be superior to pharmacological therapy regarding the prevention of the first bleeding episode, either traditional NSBBs or carvedilol seem to play a more prominent role in mortality reduction, probably due to their capacity of preventing other complications of cirrhosis through the decrease in portal hypertension. A sequential strategy, in which patients unresponsive to pharmacological therapy would be submitted to endoscopic treatment, or the combination of pharmacological and endoscopic strategies might be beneficial and deserve further investigation.     

晚期血吸虫病食管静脉曲张套扎术后早期出血的临床分析

目的 目的 探讨晚期血吸虫病 （晚血） 食管静脉曲张套扎术 （EVL） 后早期出血的发病特点。方法 方法 回顾性研究本院 收治的206例行EVL治疗的晚血患者, 统计出现术后早期出血的例次数、 好发时间、 原因或诱因、 基础疾病、 预后等。结 结 果 果 共有17例行EVL患者发生早期出血, 其中1例死亡, 早期出血率为8.25%, 死亡率为0.5%。出血均发生于术后第4 ~ 12 天, 其中发生于术后第7 ~ 9 天的有13例 （76%）。导致出血的直接原因为套扎环脱落后创面出血; 诱因是饮食不当 （10例, 58.8%） 和腹压增加 （6例, 35%）, 不明原因1例。出血均发生于首次EVL术后肝功能Child?Pugh C级患者。结论 结论 EVL术后早期出血发病率和死亡率均较低, 好发时间为术后第7 ~ 9 天, 应注意饮食因素和护理, 肝功能Child?Pugh C级 患者是早期出血的重点高危人群。     

Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis

Variceal bleeding is a life threatening situation with mortality rates of at least 20%. Prophylactic treatment with non-selective beta blockers(NSBBs) is recommended for patients with small varices that have not bled but with increased risk for bleeding. The recommended treatment strategies on primary prevention of variceal bleeding in patients with medium and largesized varices are NSBBs or endoscopic band ligation. Nitrates, shunt surgery and sclerotherapy are not recommended in this setting. In this review, the most recent data on prevention of esophageal variceal bleeding are presented. Available data derived from randomized-controlled trials suggest both treatment strategies, and according to Baveno V consensus in portal hypertension "the choice of treatment should be based on local resources and expertise, patient preference and characteristics, side-effects and contra-indications".     

超声内镜检查诊断乙型肝炎肝硬化患者食管胃底静脉曲张价值分析

目的 探讨采用超声内镜检查( EUS )诊断乙型肝炎肝硬化食管静脉曲张( EV )和胃底静脉曲张( GV )的价值。方法 2016年2月~2019年2月我院消化科就诊的乙型肝炎肝硬化患者89例(Child A级22例,B级45例和C级22例),常规行胃镜和EUS检查。结果 经常规胃镜检查,EV 检出率为46.1%,显著高于EUS检查的28.1%(P<0.05),而GV检出率为30.3%,显著低于EUS检查的39.3%(P<0.05);在Child B级和C级患者,EUS检出EV分别为24.4%和50.0%,显著低于普通胃镜检出的42.2%和81.8%(P<0.05),而在Child B级患者,EUS对GV检出率为37.8%,显著高于普通胃镜检查的22.2%(P<0.05);EUS检出食管和胃底静脉直径分别为(7.0±0.7)mm和(6.8±0.6)mm,与普通胃镜检出的【(7.1±0.6)mm和(7.1±0.6) mm, P>0.05】比,无显著性差异。结论 尽管普通胃镜是诊断食管和胃底静脉曲张的金标准,但EUS检查可作为较好的补充手段,尤其在发现GV方面有较大的应用价值,值得进一步研究     

多层螺旋CT门静脉造影与B超检查预测肝硬化食管静脉曲张出血的对比研究

目的比较多层螺旋CT门静脉造影(MSCTP)三维重建技术和B超门静脉血流动力学检查对食管静脉曲张出血(EVB)预测的准确性。方法收集60例同时行MSCTP和B超检查的肝硬化患者的临床资料,记录其实际出血的患者例数。根据胃左静脉(LGV)0.61 cm和门静脉血流量(PBF)1098.36 ml/min为预测出血的标准,记录两种方法预测出血的实际发生例数。根据预测出血例数/实际出血例数,分别计算两种方法对出血的检出率,并比较MSCTP和B超检查与胃镜检查结果的一致性。结果在60例患者中实际出血28例;LGV0.61cm对出血的检出率为89.29%,PBF1098.36 ml/min的检出率为60.71%,说明分别以MSCTP和B超检查对出血的检出率差异有统计学意义(x2=6.095,P=0.029);在28例实际出血的患者中,通过胃镜检查发现有静脉曲张出血26例,未发现出血2例;采用Mc Nemar检验发现,MSCTP与胃镜检查对EVB预测结果的差异无统计学意义(P=1.000);采用Kappa系数法分析,显示这两种方法的吻合度差异具有显著性(吻合系数K=0.781,P=0.000);B超与胃镜检查对EVB预测结果的差异具有统计学意义(P=0.012),采用Kappa系数法分析,显示这两种方法的吻合度差异无显著性(吻合系数K=0.038,P=0.747)。结论 MSCTP对预测EVB有更好的检出率,并且MSCTP与胃镜检查结果具有较高的一致性,因而对EVB具有重要的预测价值。     

Noninvasive scores for the prediction of esophageal varices and risk stratification in patients with cirrhosis

The primary purpose of variceal screening in patients with cirrhosis is to detect gastroesophageal varices at high risk of hemorrhage and implement preventative intervention(s). It was previously recommended that all patients with cirrhosis undergo initial and periodic longitudinal variceal screening via upper endoscopy. However, there has been growing interest and methods to identify patients with cirrhosis who may not have clinically significant portal hypertension and therefore be unlikely to have varices requiring intervention or benefit from upper endoscopy. Because the population of patients with compensated advanced chronic liver disease continues to grow, it is neither beneficial nor cost-effective to perform endoscopic variceal screening in all patients. Therefore, there is ongoing research into the development of methods to non-invasively risk stratify patients with cirrhosis for the presence of high-risk esophageal varices and effectively limit the population that undergoes endoscopic variceal screening. This is particularly important and timely in light of increasing healthcare reform and barriers to healthcare. In this review, we discuss and compare, with respect to test characteristics and clinical applicability, the available methods used to non-invasively predict the presence of esophageal varices.     

原发性胆汁性肝硬化患者食管静脉曲张特点及其无创预测指标研究*

目的 总结原发性胆汁性肝硬化(PBC)患者食管静脉曲张特点,探索食管静脉曲张发生的无创预测指标。方法 2010年1月~2014年12月期间我院住院治疗的122例PBC患者,常规行电子胃镜检查明确食管静脉曲张程度,应用Logistic回归分析血常规、肝功能、凝血功能指标、免疫球蛋白、腹部增强CT血管重建、腹部彩色超声多普勒检查测量门静脉（PV）和脾静脉（SV）直径以及Child-Pugh评分、MELD评分和Mayo评分共18项指标对预测PBC患者食管静脉曲张发生的价值。结果 在122例PBC患者中,16例（13%）无食管静脉曲张,106例（87%）存在不同程度的食管静脉曲张;PBC患者有食管静脉曲张与无食管静脉曲张患者Mayo评分、白蛋白、胆碱酯酶、血小板计数、门静脉和脾静脉直径具有统计学差异（P<0.05）;多因素分析显示,脾静脉直径在两组之间具有统计学差异（P=0.016）;ROC曲线下面积为0.843,当以SV=8.5 mm为截断点时,其诊断存在静脉曲张的灵敏度为72.0%,特异度为92.9%,阳性预测值为98.6%,阴性预测值为31.7%。结论 脾静脉内径可较好地预测PBC患者食管静脉曲张发生的风险,而既往国外报道的具有预测价值的血小板计数和Mayo评分在本研究中未显示出预测价值。     

内镜下套扎和注射硬化剂治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者疗效研究

目的 探讨采取内镜下套扎和注射硬化剂治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血(EVB)患者的疗效。方法 2016年2月～2021年1月在我院接受治疗的乙型肝炎肝硬化并发EVB患者80例,均接受常规抑酸、止血和输血等处理,其中40例对照组接受普萘洛尔治疗,另40例观察组患者接受内镜下套扎和注射硬化剂治疗,术后口服普萘洛尔。随访所有患者6个月。使用超声检测门静脉内径(DPV)、门静脉血流速度(VPV)和门静脉血流量(QPV),采用ELISA法检测血清胃泌素(GAS)、胃动素(MTL)、过氧化脂质(LPO)和丙二醛(MDA)水平。结果 观察组输血量、止血时间和住院日分别为(3.2±0.6) u、(23.8±5.1)h和(7.5±1.3)d,均显著少于或短于对照组[分别为(5.0±0.9) u、(47.9±7.5)h和(12.1±1.5)d,P<0.05];治疗后,观察组VPV和QPV分别为(18.7±2.3)cm/s和(510.2±52.2)ml/min,显著低于对照组[分别为(22.2±2.4)cm/s和(645.2±64.1)ml/min,P<0.05];观察组血清GA...     

内镜套扎术急症止血治疗肝硬化食管静脉曲张破裂出血的疗效观察

目的探讨食管静脉曲张破裂出血的内镜套扎术急诊止血的疗效及安全性。方法对52例乙型肝炎肝硬化食管静脉曲张破裂出血患者实施内镜下急诊套扎止血术,观察术中、术后并发症,并于术后1月复查胃镜观察食管曲张静脉消失情况。结果51例（98％）患者急诊止血成功,1例（2％）止血失败,表现为术后6天内反复便血,转外科手术治疗;术后1月复查胃镜见21例（41．2％）静脉曲张消失或基本消失,28例（54．9％）中上段食管静脉曲张基本消失,2例（3．9％）存在显著的静脉曲张。术后常见并发症有咽下不适、胸骨后隐痛、低至中度发热,发生率为15．9％,未发生严重的并发症。结论急诊套扎术治疗食管静脉曲张破裂出血疗效可靠、安全性高。     

乙肝代偿期肝硬化患者高风险食管胃底静脉曲张预测模型的构建:一项病例对照研究

背景上消化道内镜检查是判断肝硬化患者食管胃底静脉曲张的金标准.对于高风险食管胃底静脉曲张尚缺乏有效无创预测模型.目的构建并验证乙肝代偿期肝硬化患者发生高风险食管胃底静脉曲张的模型.方法回顾性分析2018-01/2020-12于天津市北辰医院和武警特色医学中心收治的276例乙肝代偿期肝硬化患者常规实验室检查和超声检查临床资料.其中81例高风险静脉曲张患者,195例非高风险静脉曲张.采用Logistic回归分析影响乙肝代偿期肝硬化患者发生高风险食管胃底静脉曲张的独立危险因素,并使用这些因素构建预测模型.使用受试者工作特征曲线(receiver operating characteristic,ROC)验证所构建模型的预测效能.结果Logistic回归显示白蛋白(albumin,ALB)水平(OR=0.825,95%CI:0.779-0.873,P=0.000)、血小板(platelet,PLT)水平(OR=0.934,95%CI:0.895-0.975,P=0.001)、门静脉宽度(OR=1.481,95%CI:1.141-1.922,P=0.002)是乙肝代偿期肝硬化患者高风险静脉曲张发生的危险因素.预测模型:Y=-0.192×ALB(g/L)-0.068×PLT计数(10⁹/L)+0.39×门静脉宽度(mm)+6.87.该模型预测高风险食管胃底静脉曲张的ROC曲线下面积为0.976,最佳诊断切点为0.767,此时的敏感度为0.968,特异度为0.882.结论基于PLT、ALB和门静脉宽度的高风险食管胃底静脉曲张预测模型具有较高诊断效能,值得今后进一步研究和推广.     

Liver fibrosis index-based nomograms for identifying esophageal varices in patients with chronic hepatitis B related cirrhosis

BACKGROUNDEsophageal varices (EV) are the most fatal complication of chronic hepatitis B (CHB) related cirrhosis. The prognosis is poor, especially after the first upper gastrointestinal hemorrhage.AIMTo construct nomograms to predict the risk and severity of EV in patients with CHB related cirrhosis.METHODSBetween 2016 and 2018, the patients with CHB related cirrhosis were recruited and divided into a training or validation cohort at The First Affiliated Hospital of Wenzhou Medical University. Clinical and ultrasonic parameters that were closely related to EV risk and severity were screened out by univariate and multivariate logistic regression analyses, and integrated into two nomograms, respectively. Both nomograms were internally and externally validated by calibration, concordance index (C-index), receiver operating characteristic curve, and decision curve analyses (DCA).RESULTSA total of 307 patients with CHB related cirrhosis were recruited. The independent risk factors for EV included Child-Pugh class [odds ratio (OR) = 7.705, 95% confidence interval (CI) = 2.169-27.370, P = 0.002], platelet count (OR = 0.992, 95%CI = 0.984-1.000, P = 0.044), splenic portal index (SPI) (OR = 3.895, 95%CI = 1.630-9.308, P = 0.002), and liver fibrosis index (LFI) (OR = 3.603, 95%CI = 1.336-9.719, P = 0.011); those of EV severity included Child-Pugh class (OR = 5.436, 95%CI = 2.112-13.990, P < 0.001), mean portal vein velocity (OR = 1.479, 95%CI = 1.043-2.098, P = 0.028), portal vein diameter (OR = 1.397, 95%CI = 1.021-1.912, P = 0.037), SPI (OR = 1.463, 95%CI = 1.030-2.079, P = 0.034), and LFI (OR = 3.089, 95%CI = 1.442-6.617, P = 0.004). Two nomograms (predicting EV risk and severity, respectively) were well-calibrated and had a favorable discriminative ability, with C-indexes of 0.916 and 0.846 in the training cohort, respectively, higher than those of other predictive indexes, like LFI (C-indexes = 0.781 and 0.738), SPI (C-indexes = 0.805 and 0.714), ratio of platelet count to spleen diameter (PSR) (C-indexes = 0.822 and 0.726), King’s score (C-indexes = 0.694 and 0.609), and Lok index (C-indexes = 0.788 and 0.700). The areas under the curves (AUCs) of the two nomograms were 0.916 and 0.846 in the training cohort, respectively, higher than those of LFI (AUCs = 0.781 and 0.738), SPI (AUCs = 0.805 and 0.714), PSR (AUCs = 0.822 and 0.726), King’s score (AUCs = 0.694 and 0.609), and Lok index (AUCs = 0.788 and 0.700). Better net benefits were shown in the DCA. The results were validated in the validation cohort.CONCLUSIONNomograms incorporating clinical and ultrasonic variables are efficient in noninvasively predicting the risk and severity of EV.     

ARFI评估肝硬化并发食管胃底静脉曲张患者出血和门静脉血栓的价值分析*

目的 探讨采用声脉冲辐射力弹性成像（ARFI）评估肝硬化并发食管胃底静脉曲张（EGV）患者出血或发生门静脉血栓的价值。方法 2015年4月~2017年6月我院收治的87例肝硬化并发EGV患者,采用AEFI测量肝实质剪切波速度（LSWV）和脾脏剪切波速度（SSWV）。采用二元Logistic回归分析影响患者发生门静脉血栓的危险因素。应用受试者工作特征曲线（ROC）下面积（AUC）分析LSWV和SSWV诊断患者出血或发生门静脉血栓的效能。结果 在随访的3个月内,发生消化道出血34例,未出血53例;EGV出血组LSWV和SSWV分别为（2.6±0.5） m/s和（3.3±0.5） m/s,显著高于EGV未出血组[分别为（1.9±0.4） m/s和（2.5±0.3） m/s,P<0.05];在87例患者中25例（28.7%）并发门静脉血栓,单因素和多因素分析显示,Child分级、门静脉内径、血小板计数、感染、腹水、肝性脑病、LSWV、SSWV、EGV分级和EGV出血为EGV患者发生门静脉血栓的危险因素;联合检测LSWV和SSWV诊断EGV患者并发门静脉血栓的AUC为0.893（0.829~0.946）,诊断效能较高。结论 采用ARFI测量LSWV和SSWV可以帮助判断肝硬化并发EGV患者门静脉血栓的发生,对临床具有一定的指导意义。     

Splenic artery ligature associated with endoscopic banding for schistosomal portal hypertension

AIM:To propose a less invasive surgical treatment for schistosomal portal hypertension.METHODS:Ten consecutive patients with hepatosplenic schistosomiasis and portal hypertension with a history of upper gastrointestinal hemorrhage from esophageal varices rupture were evaluated in this study.Patients were subjected to a small supraumbilical laparotomy with the ligature of the splenic artery and left gastric vein.During the procedure,direct portal vein pressure before and after the ligatures was measured.Upper gastrointestinal endoscopy was performed at the 30th postoperative day,when esophageal varices diameter were measured and band ligature performed.During follow-up,other endoscopic procedures were performed according to endoscopy findings.RESULTS:There was no intra-operative mortality and all patients had confirmed histologic diagnoses ofschistosomal portal hypertension.During the immediate postoperative period,two of the ten patients had complications,one characterized by a splenic infarction,and the other by an incision hematoma.Mean hospitalization time was 4.1 d(range:2-7 d).Pre-and post-operative liver function tests did not show any significant changes.During endoscopy thirty days after surgery,a decrease in variceal diameters was observed in seven patients.During the follow-up period(57-72mo),endoscopic therapy was performed and seven patients had their varices eradicated.Considering the late postoperative evaluation,nine patients had a decrease in variceal diameters.A mean of 3.9 endoscopic banding sessions were performed per patient.Two patients presented bleeding recurrence at the late postoperative period,which was controlled with endoscopic banding in one patient due to variceal rupture and presented as secondary to congestive gastropathy in the other patient.Both bleeding episodes were of minor degree with no hemodynamic consequences or need for blood transfusion.CONCLUSION:Ligature of the splenic artery and left gastric vein with supraumbilical laparotomy is a promising and less invasive method for treating presinusoidal schistosomiasis portal hypertension.