肝硬化食管胃底静脉曲张破裂出血患者的临床特点分析

Cirrhosis and esophageal variceal bleeding Clinical features of patients

目的:了解肝硬化导致食管胃底静脉曲张的临床特点及治疗方法,给临床治疗提供依据。方法:收集诊断为肝硬化合并上消化道出血,同时通过胃镜检查确诊食管胃底静脉曲张破裂出血患者,观察药物疗效,并记录其检查结果及并发症。结果:肝炎肝硬化91例(其中乙型肝炎77例,丙型肝炎14例),乙醇性肝硬化31例,淤血性肝硬化(包括布-加综合征、右心衰竭等)20例,隐源性肝硬化12例,药物性肝硬化8例。肝功分级:A等级24例,B等级53例,C等级85例。同时应用多普勒超声、CT等检查设备进行检查,其中肝脏大小正常28例,增大18例;脾脏大小正常12例。自发性腹膜炎、肝性脑病为主要的并发症,发生率分别为59.25%(96/162)、50.61%(82/162);治疗方法主要包括垂体后叶素、生长抑素及其类似物、三腔二囊管压迫及外科手术。单种方法少见,仅15.4%(25/162)。联合治疗非常常见,其中生长抑素及其类似物单独使用及联合三腔二囊管、垂体后叶素联合三腔二囊管、生长抑素及其类似物联合手术治疗最为常见。结论:肝硬化食管胃底静脉曲张破裂出血最常见病因为乙型肝炎,肝功能越差,出血几率越大。小部分患者肝脏大小正常,脾不增大。自发性腹膜炎、肝性脑病为主要的并发症。联合治疗常见,且以生长抑素及其类似物联合三腔二囊管效果最好。

Objective To understand the cause of esophageal varices with liver cirrhosis the clinical characteristics and treatment methods,to provide the basis for clinical treatment.Methods Collection a diagnosis of upper gastrointestinal bleeding in cirrhotic patients,and confirmed by gastroscopy patients with esophageal variceal bleeding,observed drug effects,and record the inspection results and complications.Results Liver cirrhosis and 91 patients（including 77 cases of hepatitis B,hepatitis C 14）,31 patients with alcoholic cirrhosis,stasis cirrhosis（including Budd-Chiari syndrome,right heart failure,etc） in 20 cases,cryptogenic cirrhosis in 12 cases,8 cases of drug-induced liver cirrhosis.Liver function grade：A grade of 24 cases,B grade 53 cases,C grade in 85 cases.At the same time Doppler ultrasound,CT and other inspection equipment to inspect,including 28 cases of normal liver size,increased in 18 cases;spleen size normal in 12 cases.Spontaneous bacterial peritonitis,hepatic encephalopathy as a major complication rate was 59.25%（96/162）,50.61%（82/162）;treatment include vasopressin,somatostatin and its analogues three balloon catheter compression and surgery.One method of rare species,only 15.4%（25/162）.Combination therapy is very common,in which somatostatin and its analogs alone and combined three-balloon catheter,vasopressin combined three balloon catheter,and surgical therapy of somatostatin and its analogues is most common.Conclusion Liver cirrhosis esophageal variceal bleeding because of the most common hepatitis B,liver function worse,the greater the chance of bleeding.Small number of patients the size of the normal liver,spleen does not increase.Spontaneous bacterial peritonitis,hepatic encephalopathy is a major complication.Combined treatment of common,and somatostatin and its analogues to the joint three-balloon catheter was the best.