电子胃镜联合腹部超声对肝硬化食管静脉曲张破裂出血的预测

Prediction of variceal bleeding in patients with liver cirrhosis by combined endoscopy and ultrasound

目的:探讨内镜及超声联合预测肝硬化门脉高压患者食管曲张静脉破裂出血危险性的价值.方法:157例2wk内未出现上消化道出血的肝硬化患者,随机分成A、B两组.A组单纯胃镜检查,观察食管静脉曲张的程度;B组胃镜检查同期行超声多普勒检测,检测门静脉、脾静脉、胃左静脉血流动力学特点.结果:随访3mo,61例患者至少发生1次曲张静脉出血.曲张静脉程度、门静脉、胃左静脉、脾静脉内径与肝硬化曲张静脉出血率呈正相关;且随着食管静脉曲张程度的加重,门静脉、脾静脉以及胃左静脉内径均呈逐渐增宽的趋势,出血组明显大于非出血组(15.3mm±2.1mm vs 12.1mm±2.0mm,11.2mm±2.3mm vs 9.3mm±1.9mm,5.3mm±0.5mm vs 3.6mm±0.4mm,均P<0.05);胃左静脉的离肝血流方向在出血组与非出血组之间存在显著性差异(P<0.01).胃镜联合超声预测食管静脉曲张出血的特异性与阳性预测值显著高于单纯胃镜检查(92.16% vs 74.47%,91.3% vs 73.33%,均P<0.05).结论:胃镜联合超声检查可提高预测食管曲张静脉出血的准确性.

AIM：To evaluate the feasibility of combined endoscopy and ultrasound for prediction of variceal bleeding in patients with liver cirrhosis.METHODS：One hundred and fifty-seven cirrhotic patients without variceal bleeding in recent two weeks were enrolled.These patients were randomly divided into two groups：patients undergoing endoscopic examination alone and those undergoing both endoscopic and color Doppler-ultrasonic examinations.The extent of esophageal varices was evaluated by endoscopy,and hemodynamic characteristics of the portal vein,left gastric vein and splenic vein were measured by ultrasound.RESULTS：There was a positive correlation among the grade of varices,the diameter of the portal vein,left gastric vein and splenic vein,and the prevalence of variceal hemorrhage.With the aggravation of varices,the diameter of the portal vein,left gastric vein and splenic vein increased.The diameter of the portal vein,splenic vein and left gastric vein was larger in patients with variceal bleeding than in those without variceal bleeding（15.3 mm ± 2.1 mm vs 12.1 mm ± 2.0 mm,11.2 mm ± 2.3 mm vs 9.3 mm ± 1.9 mm,5.3 mm ± 0.5 mm vs 3.6 mm ± 0.4 mm,all P 〈0.05）.There is a remarkable difference in blood flow of the left gastric vein from the liver to the esophageal plexus between patients with and without variceal bleeding（P 〈0.01）.The specif icity and positive predictive value of combined endoscopy and ultrasound for prediction of variceal bleeding in patients with liver cirrhosis were significantly higher than those of endoscopic examination alone（92.16% vs 74.47%,91.3% vs 73.33%,P〈 0.05）.CONCLUSION：Combined endoscopy and ultrasound can improve the accuracy of prediction of variceal bleeding in patients with liver cirrhosis.