不同食管静脉曲张内镜治疗方法对门静脉高压性胃病的影响

doi:10.16150/j.1671-2870.2016.05.006

摘要/Abstract

摘要： 目的: 分析研究不同的食管静脉曲张内镜治疗方法对门静脉高压性胃病（portal hypertensive gastropathy,PHG）的影响。方法: 连续收集2015年1月至2016年3月上海交通大学医学院附属瑞金医院消化科收治的食管静脉曲张内镜治疗患者共35例,给予内镜下硬化剂注射治疗（endoscopic injection sclerotherapy,EIS）或内镜下静脉曲张套扎术（endoscopic varix ligation,EVL）,对合并的胃静脉曲张同时给予黏合剂注射栓塞治疗。术后定期随访,随访过程中酌情追加内镜治疗,并评估患者PHG的动态变化。结果: 首次接受EIS及EVL的患者分别为17与18例;随访中,上述2组中各有16、13例患者分组不变,其余6例因操作原因、EIS后消退不理想或残余曲张静脉不适合再次行EVL而改用另一种内镜治疗（混合治疗）,平均内镜随访时间为（8.6±4.0）个月。内镜治疗前无PHG的患者17例,轻度PHG者为18例,无重度PHG患者;治疗后,无PHG、轻度PHG、重度PHG者分别为16例、16例、3例（P>0.05）。EVL与混合治疗在控制出血和维持PHG稳定方面似优于EIS,治疗前、后患者的平均总体肝功能Child评分分别为（6.77±1.73）分和（6.00±0.91）分,内镜治疗后患者的肝功能明显改善（P<0.01）。结论: 食管静脉曲张内镜治疗不会对PHG产生明显负面影响。

关键词: 门静脉高压性胃病, 静脉曲张, 内镜, 内镜下静脉曲张套扎术, 内镜下硬化剂注射治疗

Abstract: Objective: To analyze the impact of different endoscopic esophageal varices treatment on severity of portal hypertensive gastropathy(PHG). Methods: A total of 35 patients with endoscopic treatment of esophageal varices at Department of Gastroenterology, Shanghai Ruijin Hospital from January 2015 to March 2016 were enrolled. Either endoscopic injection sclerotherapy(EIS) or varices ligation(EVL) was performed, and the concomitant gastric varices, if present, was treated with tissue adhesive obturation(GVO). Additional endoscopic treatment was performed when necessary and patients were followed up for PHG evaluation. Results: Seventeen patients received EIS and 18 received EVL at the initial endoscopy. During follow-up, 16 and 13 patients of the above mentioned groups, respectively, remained in the same group, while the other 6 patients turned to receive a mixed therapy of EIS and EVL because of either technical failure, inadequate regression after EIS or residue varices not suitable for another EVL. Mean endoscopic follow-up was (8.6±4.0) months. Patients with severe, mild and absent of PHG were 0, 18, 17 at baseline and 3, 16, 16 at last follow-up, respectively (P>0.05). EVL and mixed therapy were seemed to be superior to EIS in both long-term hemostasis and PHG stability. The average Child-Pugh scores at baseline and last follow-up were (6.77±1.73) and (6.00±0.91), respectively, indicating that endoscopic treatment was beneficial to liver function improvement(P<0.01). Conclusions: Endoscopic treatment for esophageal varices would not have significant negative influence on PHG.

Key words: Portal hypertensive gastropathy, Varices, Endoscopy, Endoscopic varix ligation, Endoscopic injection sclerotherapy

中图分类号:

R575.2

吴巍, 王立夫, 陶凤来, 徐贝黎, 叶佩君, 陈舒, 袁耀宗. 不同食管静脉曲张内镜治疗方法对门静脉高压性胃病的影响[J]. 诊断学理论与实践, 2016, 15(05): 464-467.

WU Wei, WANG Lifu, TAO Fenglai, XU Beili, YE Peijun, CHEN Shu, YUAN Yaozong. Impact of different endoscopic esophageal varices treatment on portal hypertensive gastropathy[J]. Journal of Diagnostics Concepts & Practice, 2016, 15(05): 464-467.

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