孤立性胃十二指肠静脉曲张56例临床分析

ISOLATED GASTRODUODENAL VARICES: AN ANALYSIS OF 56 CASES

目的分析孤立性胃十二指肠静脉曲张的病因和治疗。方法 :从 1990年 1月～ 1999年 12月 10年间共收治门脉高压 94 6例 ,发现孤立性胃十二指肠静脉曲张 5 6例 ,对其临床资料进行分析。结果 :发病率 5 .9%。肝硬化 35例 ,占 6 2 .5 % ;胰腺疾患 11例 ,占 19.6 % ;其他 10例 ,占 17.9%。 2 1例患者呕血、黑便 ,出血率为37.5 %。外科手术治疗 19例 ,内镜下硬化治疗 8例 ,急诊止血 3例 ,血管介入栓塞治疗 1例 ,余 30例内科保守治疗。结论 :孤立性胃十二指肠静脉曲张大部分由病毒性肝炎肝硬化门脉高压引起 ,部分病因是胰腺疾患。治疗据病因不同采取不同措施 ,有手术适应证者尽量争取手术治疗 ,内镜下硬化治疗可作为孤立性胃静脉曲张急性出血时的止血手段。

Objective:To analyze the etiologies,diagnosis and therapeutic modalities of isolated gastroduodenal varices.Methods:Fifty_six cases of isolated gastroduodenal varices in 946 patients with portal hypertension were diagnosed by our two hospitals from January 1990 to December 1999,and their clinical data were analyzed.Results:The morbidity was 5.9%.We found liver cirrhosis in 35 cases (62.5%),21 cases were due to hepatitis B,among them five were complicated with hepatocellular carcinoma.Pancreatic diseases were found in 11 cases(19.6%).Other etiologies in 10 patients (17.9%) were as follows:two with lymphoma,one with portal vein cavernous degeneration,one with myelofibrosis,one with lymph node metastasis in retroperitoneal secondary to ovarian carcinoma ,and five with unknown causes.Twenty_one patients had hematemesis and /or melena,and the rate of bleeding was 37.5%.Surgery was performed in 19 cases.Eight patients were treated with sclerotherapy,and three of them received emergency treatment.Transvenous obliteration was performed in one case,and the remaining 30 cases received medical treatment.Conclusions:1. Liver cirrhosis with portal hypertension is responsible for most of the isolated gastroduoenal varices,and pancreatic diseases complicated with splenic vein obstruction are also responsible for a few cases.2. Therapy methods depend on their etiologies:surgery is a choice of treatment only for selective cases in accordance with underlying etiology;sclerotherapy can effectively control acute isolated gastric varices bleeding,but rebleeding is frequent with elective sclerotherapy.