Comparison of hepatic venous pressure gradient and endoscopic grading of esophageal varices

AIM: To determine the correlation between the hepatic venous pressure gradient and the endoscopic grade of esophageal varices.METHODS: From September 2009 to March 2013, a total of 176 measurements of hepatic venous pressure gradient (HVPG) were done in 146 patients. Each transjugular HVPG was measured twice, first using an end whole catheter (EH-HVPG), and then using a balloon catheter (B-HVPG). The HVPG was compared with the endoscopic grade of esophageal varices (according to the general rules for recording endoscopic findings of esophagogastric varices), which was recorded within a month of the measurement of HVPG.RESULTS: The study included 110 men and 36 women, with a mean age of 56.1 years (range, 43-76 years). The technical success rate of the pressure measurements was 100% and there were no complication related to the procedures. Mean HVPG was 15.3 mmHg as measured using the end hole catheter method and 16.5 mmHg as measured using the balloon catheter method. Mean HVPG (both EH-HVPG and B-HVPG) was not significantly different among patients with different characteristics, including sex and comorbid factors, except for cases with hepatocellular carcinoma (B-HVPG, P = 0.01; EH-HVPG, P = 0.02). Portal hypertension (> 12 mmHg HVPG) occurred in 66% of patients according to EH-HVPG and 83% of patients according to B-HVGP, and significantly correlated with Child’s status (B-HVPG, P < 0.000; EH-HVGP, P < 0.000) and esophageal varies observed upon endoscopy (EH-HVGP, P = 0.003; B-HVGP, P = 0.006). One hundred and thirty-five endoscopies were performed, of which 15 showed normal findings, 27 showed grade 1 endoscopic esophageal varices, 49 showed grade 2 varices, and 44 showed grade 3 varices. When comparing endoscopic esophageal variceal grades and HVPG using univariate analysis, the P value was 0.004 for EH-HVPG and 0.002 for B-HVPG.CONCLUSION: Both EH-HVPG and B-HVPG showed a positive correlation with the endoscopic grade of esophageal varices, with B-HVPG showing a stronger correlation than EH-HVPG.

改良置管法在慢性硬膜下血肿钻孔引流术中的应用

目的:探讨改良置管法在慢性硬膜下血肿钻孔引流术中的应用效果。方法:选取中山市东凤人民医院2019年3月至2020年7月期间收治的60例慢性硬膜下血肿患者,均行钻孔引流术治疗,采用电脑随机分组法将其分为对照组与观察组,各30例。对照组应用传统钻单孔冲洗引流排气法,观察组应用改良置管排气法,比较两组患者的手术治疗情况、颅内积气、感染发生情况和引流情况,术后3个月统计复发率。结果:观察组患者的住院时间短于对照组,差异具有统计学意义(P<0.05)。两组患者的手术时间、术中出血量比较,差异无统计学意义(P>0.05)。观察组患者的颅内积气、颅内感染发生率均低于对照组,差异具有统计学意义(P<0.05)。观察组患者术后1 d、2 d的引流管通畅比例高于对照组,差异具有统计学意义(P<0.05)。术后3个月,观察组复发率为6.67%(2/30),低于对照组的26.67%(8/30),差异具有统计学意义(P<0.05)。结论:在慢性硬膜下血肿钻孔引流术中应用改良置管法能够有效减少颅内积气、感染事件,维持引流管通畅,缩短患者术后恢复时间,降低复发风险。