十二指肠静脉曲张内镜诊治方法研究

Endoscopic diagnosis and therapy of duodenal varices

目的探讨十二指肠静脉曲张内镜下诊断及治疗方法。方法对2000年11月至2008年8月93283例内镜检查发现的26例十二指肠静脉曲张的内镜下表现，采用位置（L）、直径（D）、危险因素（跗）即LDRf分型方法进行分型，观察依照分型对十二指肠静脉曲张治疗的效果，并进行随访。结果内镜下分型：Ld1 5例（19．2％），Ld1.2 22例（7．7％），Ld2 19例（73．1％）；D。0例，D0.5 2例，D1 10例，D2 13例，D3 1例；Rf0 23例，Rf1 0例，Rf2 3例。其中伴食管及（或）胃底静脉曲张18例。17例住院患者中乙型肝炎肝硬化9例（52．9％）。对其中的3例Rf2患者行内镜下治疗，1例活动出血者（Ld：D，Rf2）行组织粘合剂治疗后即刻止血，1例（Ld2D2Rf2）行组织粘合剂治疗，另1例患者（Ld2D1Rf2）进行了套扎治疗，随后进行了平均14．6个月的随访，3例患者在治疗后1．0～3．5个月内静脉曲张消失，且无复发；其余患者未行内镜治疗，对其中11例进行随访，未发现静脉曲张出血，有2例患者因其他原因死亡。结论LDRf内镜下分型能基本反映十二指肠静脉曲张的内镜特点，依照该分型选择十二指肠静脉曲张内镜治疗方法是安全可行的。

Objective To evaluat the endoscopic diagnosis and treatment of duodenal varices. Meth- ods Twenty-six cases of duodenal varices detected by endoscopy from a total of 93 283 patients from Novem- ber 2000 to August 2008, were classified according to the location, diameter and risk factor （LDRf） of the varices. The patients were treated according to the classification and followed. Results The duodenal varices were classified as Ld1 （5, 19.2% ）, Ld1.2 （2, 7.7% ） and Ld2 （ 19, 73.1% ） ; DO （0）, D0.3 （2）, D1 （10）, D2 （ 13 ） and D3 （ 1 ） ; Rf0 （23）, Rf1 （0） and Rf2 （ 3 ）. Of 26 patients, 18 were accompanied with esophageal and （or） gastric fundic varicosis. Hepatitis B-related cirrhosis occurred in 9 of 17 hospitalized cases, of which 3 cases of Rf2 were treated with endoscopic procedures. Histoacry injection was performed in 1 patient of Ld2D3Rf2 to stop active bleeding and in another patient of Ld2D2Rf2, endoscopic ligation was performed in 1 case of Ld2Dl Rf2. The patients were followed up for 14. 6 months on average. Duodenal varicosis in 3 patients vanished in 1.0-3.5 months after the treatment, and there was no recurrence. Of those patients who did not re- ceive endoscopic treatment, 11 were followed up, and no varices bleeding was found. Two patients died of other reasons. Conclusion LDRf classification can reflect endoscopic features of duodenal varicosis, and it is safe and feasible to choose therapy according to LDRf classification.