门静脉高压性胃病急性出血的临床诊断

The clinical diagnosis of hemorrhagic portal hypertensive gastropathy(PHG)

目的:探讨门静脉高压性胃病(portal hypertensive gastropathy,PHG)急性出血的临床诊断,分析PHG的病因、内镜下特点和治疗后转归。方法:收集2013年1月至2016年6月间上海交通大学瑞金医院北院消化内科196例门静脉高压症(门脉高压症)出血的患者,分析其临床资料、内镜检查结果及治疗后转归情况。结果:196例门脉高压出血患者中,内镜诊断为PHG 67例(34.2%),其中轻度PHG 49例(25.0%),重度PHG 18例(9.2%)。经内镜检查证实,5例重度PHG(2.6%)为本次出血的直接原因,13例重度PHG(6.6%)为本次出血的原因之一。所有重度PHG出血患者经血管活性药物及内镜治疗后,急性出血均得到控制。结论:PHG在门脉高压症患者中并不少见,轻度PHG一般不会出血,但应注意其临床演进;重度PHG在内镜下主要表现为广泛樱桃红样出血红斑及弥漫性出血性胃炎,可引起上消化道大量出血,各种降低门静脉压力的治疗方法能有效控制其出血。

Objective： To investigate the clinical diagnosis of acute hemorrhagic portal hypertensive gastropathy（PHG） and to analyze the endoscopic appearance and therapeutic outcome in PHG patients. Methods： Clinical data, endoscopic results and outcome of 196 patients with upper gastrointestinal bleeding caused by portal hypertension in Ruijin Hospital North were collected and analyzed. Results： Sixty-seven patients with PHG were verified by endoscopy, which comprised 34.2% of total patients, including 49 patients with mild PHG（25.0%）, 18 patients with severe PHG（9.2%）; 5 patients（2.6%） with gastrointestinal bleeding were caused by severe PHG solely, which were verified by endoscopy, and 13patients（6.6%） with bleeding were partially caused by severe PHG. All of the acute bleeding caused by severe PHG were stopped after therapy with vasoactive agents and endoscopic sclerotherapy. Conclusions： PHG is common in patients with portal hypertension. Mild PHG usually does not tend to cause bleeding, but its progression merits attention. The main endoscopic pattern of severe PHG is extensive cherry-red spots and diffuse hemorrhagic gastritis, which may lead to massive upper gastrointestinal bleeding. Treatment for reducing portal hypertension can effectively control bleeding caused by PHG.