超声对预测食管静脉破裂出血的价值:与食管静脉测压对照分析

目的:与食管曲张静脉测压对比评价彩色多普勒超声对预测肝硬化门脉高压症食管静脉破裂出血的价值。方法:利用食管曲张静脉测压仪测量20例正常人及23例肝硬化门脉高压症患者食管静脉压,同时采用彩色多普勒超声探测其门、脾静脉内径、流速及流量。结果:(1)正常人与门脉高压患者的门、脾静脉内径及流量存在显著性差异(P<0.01);(2)门静脉流量与食管曲张静脉测压间呈良好正相关(r=0.956,P<0.01)。当食管静脉压≥20mmHg时,易发生食管静脉破裂出血,符合率为73.33％;(3)超声结果分析显示食管静脉压≥20mmHg组在门、脾静脉内径、流量上存在显著性差异(P<0.01)。结论:超声探测门、脾静脉内径及流量简便易行,对预测食管静脉破裂出血有重要价值。

食管曲张静脉内镜气囊测压法的实验研究

目的 体外验证食管曲张静脉内镜气囊测压法。方法 制备并组装食管模型及食管内曲张静脉模型 ,用食管曲张静脉测压仪进行测压。结果 不同直径 (3、6、8mm)食管曲张静脉内镜气囊测压值与实际压力值间均呈现良好的直线回归 (r=0 983～ 0 995 ) ,未发现明显的测量偏差 ,但细的食管曲张静脉 (3mm)测压值变化较大 (偏差 =- 0 0 77kPa±0 0 2 5kPa)。模拟的食管弹性对测压值无影响。不同内镜操作者不影响所测的压力值。结论 内镜下气囊测压法对大、中食管曲张静脉测压结果可靠 ,且不被食管壁的弹性所影响。

硝酸甘油加胃复胺对食管曲张静脉压的影响

食管曲张静脉破裂出血是肝硬化门脉高压的严重并发症。硝酸甘油能降低门脉压^(〔1〕),胃复胺可增加下食管括约肌压力,减少奇静脉血流量^(〔2〕)。为观察这两种药物联合应用对曲线静脉压的影响。

食管曲张静脉微创测压研究

目的 研制微创性食管曲张静脉测压仪并探讨其可行性及临床应用价值。方法 食管曲张静脉测压仪由气路部分、气敏探头、电路部分、数据处理部分和压力控制手柄组成。采用配对设计 ,动物实验研究静脉穿刺测压值与贴壁测压值的直线相关关系。临床研究 ,2 0例Ⅱ～Ⅳ度食管静脉曲张患者食管曲张静脉贴壁测压值与肝静脉压力梯度值的直线相关关系。以 6mm为界 ,将食管曲张静脉分为两组 ,对两组食管曲张静脉压力大小进行比较。结果 动物实验研究穿刺测压值与微创性贴壁测压值有直线相关关系 (r =0 .99,P <0 .0 0 1)。临床研究食管曲张静脉贴壁测压值与肝静脉压力梯度值有直线相关关系 (r=0 .81,P <0 .0 5 )。大口径组患者食管曲张静脉压力大于小口径组 (P <0 .0 5 )。结论 微创性测压仪能准确测定静脉内压 ,食管曲张静脉压力测量有临床应用价值 ,食管曲张静脉压力与曲张静脉破裂出血相关。

Right liver lobe/albumin ratio:Contribution to non-invasive assessment of portal hypertension

AIM： To study the value of biochemical and ultrasonographic parameters in prediction of presence and size of esophageal varices.METHODS： The study includes selected cirrhotic patients who underwent a complete biochemical workup, upper digestive endoscopic and ultrasonographic examinations. Albumin/right liver lobe diameter and platelet count/spleen diameter ratios were calculated. The correlation between calculated ratio and the presence and degree of esophageal varices was evaluated.RESULTS： Ninety-four subjects （62 males, 32 females）, with a mean age of 52.32 ± 13.60 years, were studied. Child-Pugh class A accounted for 42.6%, class 13 37.2%, whereas class C 20.2%. Esophageal varices （OE） were not demonstrated by upper digestive endoscopy in 24.5%, while OE grade Iwas found in 22.3% patients, grade Ⅱ in 33.0%, grade m in 16.0%, and grade iV in 4.3%. The mean value of right liver lobe diameter/ albumin ratio was 5.51± 1.82 （range from 2.76 to 11.44）, while the mean platelet count/spleen diameter ratio was 1017.75 ± 729.36 （range from 117.39 to 3362.50）, respectively. Statistically significant correlation was proved by Spearman＇s test between OE grade and calculated ratios. The P values were 0.481 and -0.686, respectively.CONCLUSION： The right liver lobe diameter/albumin and platelet count/spleen diameter ratios are noninvasive parameters providing accurate information pertinent to determination of presence of esophageal varices, and their grading in patients with liver cirrhosis.

Multiple esophageal variceal ruptures with massive ascites due to myelofibrosis-induced portal hypertension

A 75-year old man had been diagnosed at 42 years of age as having polycythemia vera and had been monitored at another hospital. Progression of anemia had been recognized at about age 70 years, and the patient was thus referred to our center in 2008 where secondary myelofibrosis was diagnosed based on bone marrow biopsy findings. Hematemesis due to rupture of esophageal varices occurred in January and February of 2011. The bleeding was stopped by endoscopic variceal ligation. Furthermore, in March of the same year, hematemesis recurred and the patient was transported to our center. He was in irreversible hemorrhagic shock and died. The autopsy showed severe bone marrow fibrosis with mainly argyrophilic fibers, an observation consistent with myelofibrosis. The liver weighed 1856 g the spleen 1572 g, indicating marked hepatosplenomegaly. The liver and spleen both showed extramedullary hemopoiesis. Myelofibrosis is often complicated by portal hypertension and is occasionally associated with gastrointestinal hemorrhage due to esophageal varices. A patient diagnosed as having myelofibrosis needs to be screened for esophageal/gastric varices. Myelofibrosis has a poor prognosis. Therefore, it is necessary to carefully decide the therapeutic strategy in consideration of the patient's concomitant conditions, treatment invasiveness and quality of life.

Comparison of esophageal capsule endoscopy and esophagogastroduodenoscopy for diagnosis of esophageal varices

AIM： To investigate the utility of esophageal capsule endoscopy in the diagnosis and grading of esophageal varices. METHODS： Cirrhotic patients who were undergoing esophagogastroduodenoscopy （EGD） for variceal screening or surveillance underwent capsule endoscopy. Two separate blinded investigators read each capsule endoscopy for the following results： variceal grade, need for treatment with variceal banding or prophylaxis with beta-blocker therapy, degree of portal hypertensive gastropathy, and gastric varices. RESULTS： Fifty patients underwent both capsule and EGD. Forty-eight patients had both procedures on the same day, and 2 patients had capsule endoscopy within 72 h of EGD. The accuracy of capsule endoscopy to decide on the need for prophylaxis was 74%, with sensitivity of 63% and specificity of 82%. Interrater agreement was moderate （kappa = 0.56）. Agreement between EGD and capsule endoscopy on grade of varices was 0.53 （moderate）. Inter-rater reliability was good （kappa = 0.77）. In diagnosis of portal hypertensive gastropathy, accuracy was 57%, with sensitivity of 96% and specificity of 17%. Two patients had gastric varices seen on EGD, one of which was seen on capsule endoscopy. There were no complications from capsule endoscopy.CONCLUSION： We conclude that capsule endoscopy has a limited role in deciding which patients would benefit from EGD with banding or beta-blocker therapy. More data is needed to assess accuracy for staging esophageal varices, PHG, and the detection of gastric varices.