肝硬化并上消化道出血的胃镜表现及其临床意义(附156例分析)

Analysis of Gastric Endoscopy Features and Clinical Implication in 156 Patients with Upper Gastrointestinal Hemorrhage of Hepatocirrhosis

目的对肝硬化并上消化道出血患者的食管静脉曲张程度、胃粘膜病损程度以及幽门螺杆菌(Hp)感染情况进行相关性分析。方法肝硬化并上消化道出血患者行急诊胃镜检查,食管静脉曲张根据其内镜表现分无、轻、中、重度;门脉高压性胃病(PHG)按McCormack内镜诊断标准分类;Hp检测采用快速尿素酶试验和14C尿素呼气试验。结果156例上消化道出血患者中,食管静脉曲张破裂出血82例,占52.8%(82/156);PHG出血40例,占26.3%(40/156);消化性溃疡16例,占11.3%(16/156);胃癌2例;急性胃黏膜病变4例;其他不明原因12例。且食管静脉曲张程度与PHG病变程度呈明显正相关(P<0.01)。Hp检测阳性62例,其中食管静脉曲张破裂出血中29例,PHG中19例,消化性溃疡中9例,其他5例,且Hp感染与食管静脉曲张及PHG的病变程度无关(P>0.05)。结论食管静脉曲张破裂出血与门脉高压性胃病出血是引起肝硬化并上消化道出血的两大主要原因,且随着食管静脉曲张程度的加重,门脉高压性胃病逐渐增多和加重;Hp感染与肝硬化并上消化道出血无关,是否给予根除Hp治疗尚有待商榷。

Objective To analyse the relationship between the varicosity of esophagus and portal hypertensive gastropathy（ PHG）, and the incidence of Hp infection in of hepatocirrhosis. Methods The damage degree of esophageal patients with upper gastrointestinal hemorrhage varicosity was divided into four grades and the PHG were divided into three groups according to the McCormack and H. pylori were detected by experiments of fast urease and 14C （52.8%） were induced by esophageal varicosity explosion and 40 other causes. There was significant positive association between the PHG （P〈0.01）. peptic ulcer and 5 standards by emergency gastric endoscopy, urea expiration. Results Of all patients, 82 （26.3%） were due to PHG,34 were due to damage degree of esophageal varicosity and In 62 Hp-positive patients, there were 29 cases of esophageal varicosity, 19 of PHG, 9 of of others, respectively. The incidence rate of Hp infection had not significant association with the damage grade of esophageal varicosity and PHG（ P 〉 0.05 ）. Conclusion The esophageal varicos.ity explosion and PHG are two major factors in upper gastrointestinal hemorrhage of hepatocirrhosis. The more severe is the damage degree of esophageal varicosity, the more high is the incidence rate of PHG. Rate of Hp infection has not association with upper gastrointestinal hemorrhage of hepatocirrhosis, so it is undefined to get ride of Hp in its treatment.