门静脉高压脾切除门奇静脉离断术后再出血的食管胃静脉曲张分类研究

Types of esophagogastric varices in portal hypertension patients with upper gastrointestinal rebleeding after splenectomy and devascularization

目的:探讨门静脉(门脉)高压患者脾切除门奇静脉离断术(脾切断流术)后再发上消化道出血的平均时间、内镜下食管和胃静脉曲张的分类特点及门脉高压性胃病的发病率。方法:190例肝硬化门脉高压出血患者分为脾切断流术后再出血组(40例)和未行手术组(150例),统计手术患者术后至首次出血的平均时间间隔,每组患者分别行内镜检查,观察并对比其曲张静脉的分型特点及门脉高压性胃病发生率。结果:脾切断流术后再发出血时间平均为24个月,再出血患者内镜皆提示存有食管和(或)胃静脉曲张,2组患者内镜下的曲张静脉分型构成比有明显差异,脾切断流术者以单纯食管静脉曲张及食管胃静脉曲张(GOV)1型为主,未发现孤立性胃静脉曲张(IGV)1型及IGV2型,60.0%患者存在门脉高压性胃病,其发病率及严重程度均高于未行手术组患者。结论:脾切断流术治疗门脉高压近期止血疗效确切,但术后曲张静脉并未有效消退,须强调手术的规范性,并在再出血高发时段定期内镜随访,及时掌握食管胃曲张静脉及门脉高压性胃病的发展情况,早期干预治疗,从而改善患者预后。

Objective To observe the mean time interval of upper gastrointestinal rebleeding after splenectomy and devascularization for the treatment of portal hypertension and to investigate the type of esophagogastric varices and the prevalence of portal hypertensive gastropathy （PHG）. Methods A total of 190 patients with portal hypertension were divided into operated group （40 patients） with rebleeding after splenectomy and devaseularization and non-operation group （150 patients）. The two groups of patients were examined by gastroscopy and analyzed for the type of esophagogastric varices and observed the prevalence of PHG. Results The mean time interval of upper gastrointestinal rebleeding after operation was 24 months. It was demonstrated that all the patients of operation rebleeding group had esophagogastric variees. The types of esophagogastric varices were significantly different between the two groups. In operated group, simple esophageal varices and esophagogastric varices type 1（GOV1） were the predominant ones; isolated gastric varices type 1 （IGV 1） and IGV 2 were not seen. About 60.0% of patients had PHG,the prevalence rate and grade of PHG were higher than that of non-operation group. Conclusions Splenectomy and devaseularization had short term effect for stopping the bleeding, but the varices did not regress effectively. It is important to emphasize the standardization of the operation, and follow-up with gastroscopy regularly to detect the progress of varices and development of PHG. Taking intervention measures earlier is helpful for improving patients＇s prognosis.