孤立性胃静脉曲张的临床特点及内镜形态分析

A study on clinical and endoscopic features of isolated gastric varices

目的:分析孤立性胃静脉曲张的临床和内镜形态特征。方法 :收集2007年1月至2015年5月期间我科经胃镜检查确诊为胃食管静脉曲张破裂出血的住院患者340例,其中孤立性胃静脉曲张38例(11.2%)。分析其病史资料、内镜所见、治疗情况及随访结果。结果:38例患者中常见病因分别为乙型肝炎后肝硬化(8例)、胰源性门静脉高压症(8例)及隐源性肝硬化(7例)。胃曲张静脉最常累及的区域分别为胃底大弯侧(84%)及胃底后壁侧(29%);形态上以多发结节状最常见(53%),其次为巨瘤状(37%);色泽上大多与周围正常黏膜相同(87%),且表面红色征少见(21%)。29例患者接受了内镜下硬化剂及组织黏合剂联合注射治疗术,所有患者对操作耐受良好,围手术期内未发生严重并发症。结论:孤立性胃静脉曲张为一少见疾病,其内镜形态复杂,缺乏明显色泽改变。胰源性门静脉高压症为其重要病因之一。内镜治疗可有效消退此类曲张静脉。

Objective To investigate the clinical and endoscopic features of isolated gastric varices. Methods Three hundred and forty inpatients diagnosed endoscopically as gastroesophageal variceal bleeding during January 2007 and May 2015 were enrolled, and of them 38 patients （l 1.2%） were diagnosed as isolated gastric varices. Medical history, endoscop- ic features, treatment and follow-up results were analyzed. Results Etiology of the 38 patients with isolated gastric varices included post-hepatitis B virus （HBV） infection cirrhosis（n=8）, pancreatic segmental portal hypertension（n=8） and crypto- gen^c cirrhosis（n=7）. Variees were most frequently seen in the greater curvature （84%） and posterior wa11（29%） of the fun- dus. Multiple nodules （53%） and fungating type（37%） were the frequently presented form. Most lesions didn＇t present with color changes as compared with normal mucosa nearby（87%）, and red signs were found only in 21% of the patients. Twen- ty-nine patients received endoscopic gastric varices obturation deploying both sclerosant and cyanoacrylate. The procedure was well tolerated and no severe adverse events were seen. Conclusions Isolated gastric varices are much less common than esophageal varices, with various endoscopic appearances and absence of marked mucosal color changes. Pancreatic segmental portal hypertension is one of the most important causes. Endoscopic treatment is an effective method for amelio- rating the varices.