应用微超声探头观察食管静脉曲张结扎术后曲张静脉的演变

Observation of ligated esophageal varices by ultrasonic microprobe

目的应用微超声探头进一步研究内镜下食管静脉曲张结扎术(EVL)对食管静脉曲张的治疗效果及判断预后。方法对40例中、重度食管静脉曲张的患者行食管静脉曲张结扎术 ,治疗前及治疗后2、4、8、12周在胃镜检查的同时应用微超声探头(UMP)探测曲张静脉内径、食管深层静脉的扩张程度及有无交通支的建立。结果EVL前 ,UMP可以观察和测量食管可见的曲张静脉 ,还可探测到食管深层的曲张静脉及交通支。EVL后 ,UMP与胃镜观察到的结果一致 ,均表现为曲张静脉的回缩 ,但胃镜表现F0的7例患者有3例UMP探测到曲张静脉。食管壁纤维化于EVL术后2周时即出现并局限在食管粘膜浅层。侧枝循环于术后4周时开始建立 ,12周时程度最严重。结论胃镜下微超声探头检查是一种先进的诊断方法 ,集安全、简便、客观、准确、重复性好于一身 ,它可以比胃镜更客观准确地描述EVL前后曲张静脉及周围血管的闭塞和再扩张情况 。

Objective Ultrasonic microprobe (UMP) was used in this study to estimate the sequalae of EVL (endoscopic variceal ligation) on esophageal varices (EV). Methods EVL was practised on 40 patients with moderate to severe esophageal varices. Ultrasonography via UMP were studied in association with gastroscope before and 2, 4, 8 and 12 weeks after EVL to define the calibre of varices, dilatation of deep varices and establishment of communicating channels. Results Prior to EVL with UMP the EVs could be viewed and measured; there existed also varices and collateral veins in deep layer of gullet. After EVL ultrasonography showed variceal contractures, same as that seen in gastroscopy. 3/7 cases with so- called Fo (free of varicosity) under gastroscope were found still to have varices by UMP. Fibrosis within esophageal mucosa occurred two weeks after EVL. Collateral circulation initiated by 4 weeks and developed to maximum at about 12 weeks. Conclusion Endoscopic ultrasonography is an advanced technique to evaluate the efficacy of EVL and thereby is likely to predict the prognosis.