胃镜检查肝硬化合并上消化道出血的临床研究

Clinical study for the characters by gastric endoscopy in patients with hepatic cirrhosis complicated with upper gastrointestinal hemorrhage

目的对肝硬化合并上消化道出血患者做胃镜检查,观察食管静脉曲张程度、门脉高压性胃病(PHG)情况、胃黏膜病变程度,探讨导致上消化道出血的其他病因,并对食管静脉曲张程度与胃黏膜病损程度进行相关性分析。方法对肝硬化合并上消化道出血患者进行急诊胃镜检查,观察食管静脉曲张程度,根据其内镜表现分为无、轻、中、重度4级;门脉高压性胃病(PHG)按Comgack内镜诊断标准分3类[1]。结果120例上消化道出血患者,食管静脉曲张破裂出血98例占82.7%(98/120);PHG出血54例占45%(54/120);非食管静脉曲张和非PHG22例,占出血总数的18.3%(22/120),其中急性胃黏膜病变出血10例(0.8%),消化性溃疡出血8例(0.6%),其他不明原因出血4例(0.3%);食管静脉曲张程度与PHG病变呈明显正相关(P<0.01)。结论食管静脉曲张破裂出血与PHG出血是引起肝硬化合并上消化道大出血的主要原因;随着食管静脉曲张程度的加重,PHG逐渐增多和加重,食管静脉曲张破裂出血与PHG可同时并存;急性胃黏膜病变与消化性溃疡等也是导致肝硬化上消化道大出血的常见原因。

Objective To exam the patients with hepatocirrhosis by gastric endoscope in upper gastro- intestinal hemorrhage, to observe the degree of esophageal varicosity and pathological changes of gastric mucosa and portal hypertensive gastropathy（ PHG）, to inquire into the other reasons of upper gastrointestinal hemorrhage and to analyze the correlation between the degree of esophageal varicosity as well as pathological changes of gastric mucosa. Methods The degree of esophageal varicosity was divided into four grades accoroing to the examination results detected by endoscope. The PHG was divided into three groups based on the Cormack standards by emergent gastric endoscopy. Results Among 120 patients with upper gastrointestinal hemorrhage, 98 cases （ 82.7% ） were caused by esophageal varicosity explosion and 54 cases （45%） were induced by PHG,22 cases were （ 18.3% ） were due to other causes such as acute gastric mueosa and peptic ulcer and so on. The degree of esophageal varicosity was positively related with PHG （ P 〈 0. 01 ）. Conclusion The esophageal varicosity ex- plosion and PHG are two major factors to cause hepato-cirrhosis complicated with upper gastrointestinal hemorrhage. The more sever the damage degree of esophageal varicosity is, the higher incidence and the more sever the PHG will be, acute gastric mucosa and peptic ulcer are very reasons of upper gastrointestinal hemorrhage.