超声内镜对食管静脉曲张结扎术前后侧枝循环变化的临床研究

Observation on the esophageal varices and their collaterals with ultrasonic microprobe before and after EVL

目的 应用Fujinon SP-701小探头超声内镜观察食管静脉曲张结扎术(EVL)前后曲张静脉及侧枝循环的变化,分析影响疗效的原因.选择合理的治疗方法。方法 对60例单纯食管静脉曲张出血患者依超声检查结果分为3组:Ⅰ组为单纯食管静脉曲张(EV);Ⅱ组为合并有食管旁静脉(PEV),但无交通枝(PV);Ⅲ组合并有食管旁静脉及交通枝.患者EVL术后4、8、12周行超声内镜检查,观察及测量EV、PEV、PV的变化情况,分析影响疗效的原因。结果 Ⅰ组显效率75％,复发率16％,疗效最佳;Ⅲ组显效率0％,复发率100％,疗效最差。Ⅰ组24例中出现PEV者12例;Ⅱ组20例PEV全部增宽,11例出现PV;Ⅲ组全部有PEV增宽、PV增多增宽表现。结论 超声内镜对食管静脉曲张出血治疗方法的选择有指导意义。单纯食管静脉曲张EVL可获得满意疗效,但是伴PEV及PV者不是EVL适应证,建议采用其他方法治疗。

Objective In order to evaluate the efficacy of esophageal varices ligation( EVL) , ultrasonic microprobe (UMP) was used to observe the esophageal varices and their collaterals before and after EVL. Methods Sixty patients merely with esophageal varices underwent ultrosonography via UMP before and 4,8,12 weeks after EVL and were divided into three groups:( Ⅰ )esophageal varices(EV) ( Ⅱ )esophageal and paraesophageal vein(PEV) varices( Ⅲ ) esophageal, para esophageal and perforating vein( PV) varices. Results In the following-up, the effective rate of type Ⅰ , Ⅱ , Ⅲ were 75% , 25% , 0% ; The recurrence rate 16% , 75% , and 100% respectively. PEV occurred in 12 out of 24 cases of group Ⅰ and broadened in all of the cases of group Ⅱ and Ⅲ; PV occurred in 11 out of 20 cases of group Ⅱ and all cases in groups M , and broadened in all cases of group Ⅲ. Conclusion Endoscopic ultrasonography can be served as guidance in selecting therapeutic measure in treating EV. EVL is merely suitable in treating EV; in EV patients with PEV and/or PV measures other than EVL should he selected.