肝硬化并上消化道出血的胃镜表现及临床分析

Clinical analysis for the characters detected by gastric endoscopy in patients with hepatocirrhosis complicated with upper gastrointestinal hemorrhage

目的对肝硬化并上消化道出血患者的食管静脉曲张程度、胃黏膜病损程度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Cormack内镜诊断标准分3类。结果160例上消化道出血患者中,食管静脉曲张破裂出血83例占51.9%(83/160);PHG出血42例,占26.3%(42/160);消化性溃疡16例占10.0%(16/160);胃癌2例;急性胃黏膜病变4例;其他不明原因13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)。结论食管静脉曲张破裂出血与PHG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,PHG胃病逐渐增多和加重。

Objective To analyze the correlation between the degree of esophageal varicosity as well as pathological cluao.ges of gastric mucosa and portal hypertensive gastropathy（PHG） in patients with upper gastrointestinal hemorrhage caused by hepatocirrhosis. Methods The degree of esophageal varicosity was divided into four grades according to the examination results detected by endoscope. The PHG was divided into three groups based on the Cormack Standards by eniergent gastric endosco.py. Results Among 160 patients with upper gastrointestinal hemorrhage, 83 cases（51.9% ） were caused by esophageal varicosity explosion and 42 cases（26.3 % ） were induced by PHG, 16 cases （10.0%） were due to gastric ulcer, 2 cases were induced by gastric carcinoma,4 cases were caused by pathological changes of acute gastric mucosa and 12 eases wen duo to other causes. The degree of esophageal varicosity was positively related with PHG （ P 〈 0.01）. Conclusion The esophageal varicosity explosion and PHG are two major factors to cause hepatocirrhosis complicated with upper gastrointestinal hemorrhagein. The more severe the damage degree of esophageal varicosity is, the higher incidence and the more severe the PHG will be.