急诊内镜在肝硬化上消化道出血中的应用价值(附116例报道)

THE VALUE OF EMERGENCY ENDOSCOPY FOR UPPER GASTROINTESTINAL HEMORRHAGE OF HEPATIC CIRRHOSIS(116 CASES)

目的分析门静脉高压时上消化道出血原因,了解胃粘膜的改变,评价急诊内镜检查的价值。方法回顾性分析了116例肝硬化门静脉高压合并急性上消化道出血患者行急诊内镜检查的临床资料。结果116例患者中,Ⅲ度食管静脉曲张76例,合并反流性食管炎15例(12.4%),胃十二指肠溃疡24例(19.0%),急性胃粘膜病变29例(25%)。102例(87.9%)镜下见到出血灶,其中见静脉曲张破裂出血84例(82.3%),非静脉曲张破裂出血18例(17.7%),14例(12.1%)未发现明确出血原因。40例行胃粘膜活检,病理结果均提示门静脉高压性胃病。结论肝硬化门静脉高压患者出现上消化道出血时,行急诊内镜检查是安全的,应积极行急诊内镜检查以明确出血原因,指导临床治疗。

OBJECTIVE: TO ANALYSE THE CAUSE OF UPPER GASTROINTESTINAL HEMORRHAGE OF HEPATIC CIRRHOSIS, EXPLORE THE ALTERATION OF GASTRIC MUCOSA, AND EVALUATE THE VALUE OF EMERGENCY ENDOSCOPY. METHOD: THERE WERE 116 CASES OF HEPATIC CIRRHOSIS COMPLICATED WITH UPPER GASTROINTESTINAL HEMORRHAGE WHOSE CLINICAL DATA OF EMERGENCY ENDOSCOPY WERE ANALYSED RETROSPECTIVELY. RESULT: THERE WERE 76 CASES OF ESOPHAGEAL VARICES OF 3RD DEGREE,15 CASES OF REFLUX ESOPHAGITIS, 24 CASES OF GASTRODUODENAL ULCER, AND 29 CASES OF ACUTE GASTRIC MUCOSA LESION AMONG 116 CASES. THERE WERE 102 CASES WHO WERE FOUND HEMORRHAGIC SPOTS UNDER ENDOSCOPY,AMONG WHICH 84 CASES WERE FOUND VARICES BLEEDING(VB) AND 18 CASES WERE FOUND NON-VARICES BLEEDING(NVB). FOURTEEN CASES WERE NOT FOUND HEMORRHAGIC SPOTS UNDER ENDOSCOPY. AMONG 116 CASES, THERE WERE 40 CASES WHO GOT PATHOLOGIC BIOPSY AND SHOWED THAT ALL HAD GASTROPATHY OF PORTAL HYPERTENSION. CONCLUSION: IT IS SAFE AND ESSENTIAL TO HAVE EMERGENCY ENDOSCOPY CHECK IN ORDER TO CLARIFY THE REASON OF UPPER GASTROI-NTESTINAL HEMORRHAGE WHEN CONFRONTING PORTAL HYPERTENSION OF HEPATIC CIRRHOSIS.