超声内镜预测肝硬化合并食管胃底静脉曲张破裂出血的临床观察

胡华华 刘俊 关丽愉 许捷鸿 易宏 李中专 覃树芬 邓翔宇

[摘要] 目的 探索超聲内镜预测肝硬化合并食管胃底静脉曲张破裂出血的临床效果。方法 回顾性分析2017年10月—2018年10月间在该院确诊为肝硬化合并食管胃底静脉曲张经超声胃镜定期随访的86例患者的临床资料。随访结局按照是否出现静脉破裂出血进行分组，其中出血组（研究组）30例和未出血组（对照组）56例，比较两组患者随访过程中经超声测算出的食管壁内外及交通支曲张静脉的平均内径、平均血流速度、平均血流量等指标的均值差异，试图分析所得指标对静脉破裂出血结局的意义，评估超声内镜预测肝硬化合并食管胃底静脉曲张破裂出血的价值。结果 研究组的食管壁内外及交通支曲张静脉的平均内径、平均血流速度、平均血流量均显著高于对照组（P<0.05）。Pearson 相关分析表明食管静脉曲张破裂出血结局与性别、年龄、病程、肝功能child-pugh评分、血小板计数相关性不大（P>0.05），与平均静脉内径、平均血流速度和平均血流量呈正相关（P<0.05）。结论 食管壁内外及交通支曲张静脉的平均内径、平均血流速度、平均血流量与胃底静脉曲张破裂出血结局关系密切，利用超声内镜监测这些指标，能够提前预测肝硬化合并食管胃底静脉曲张破裂出血的结局。

[关键词] 超声内镜;肝硬化;静脉曲张;出血

[Abstract] Objective To explore the clinical effect of endoscopic ultrasound in predicting cirrhosis and esophageal gastric varices rupture and bleeding. Methods The clinical data of 86 patients with cirrhosis and esophageal gastric varices diagnosed in the hospital from October 2017 to October 2018 were analyzed retrospectively. Follow-up outcomes were grouped according to whether venous rupture bleeding occurred，of which 30 cases were in the bleeding group （study group） and 56 cases were in the non-bleeding group （control group）. The inside and outside of the esophagus wall and the traffic branch were calculated by ultrasound during the follow-up of the two groups. Variations in the mean diameter of varicose veins，average blood flow velocity，and average blood flow were used to analyze the significance of the obtained indicators for venous rupture and bleeding outcomes，and to evaluate the value of endoscopic ultrasound in predicting cirrhosis and esophageal gastric varices rupture bleeding. Results The average inner diameter，average blood flow velocity，and average blood flow of the esophageal wall and the varicose veins in the study group were significantly higher than those in the control group （P<0.05）. Pearson correlation analysis showed that the outcome of esophageal varices bleeding was not related to gender，age，course of disease，liver function child-pugh score，and platelet count （P>0.05），and it was related to the average venous diameter，average blood flow velocity，and average blood flow. There was a positive correlation （P<0.05）. Conclusion The average diameter，average blood flow velocity and average blood flow of the varicose veins in and around the wall of the esophagus and the transportation branches are closely related to the outcome of gastric varicose vein rupture and hemorrhage. The use of endoscopic ultrasound monitoring of these indicators can predict the outcome of cirrhosis with esophageal and gastric varicose vein rupture and hemorrhage in advance.

[Key words] Endoscopic ultrasound; Cirrhosis; Varicose veins; Bleeding

食管静脉曲张破裂出血是肝硬化门静脉高压症患者最凶险的并发症，肝硬化患者食管静脉曲张（esophageal varices，EV）发生率为80%～90%，食管胃底静脉曲张破裂出血（esophagogastric variceal bleeding，EVB）发生率约33.3%，而其中的50%将死于第一次出血，占肝硬化患者死亡病因的1/3，另2/3的患者终身不会发生出血[1]。因此有效预测肝硬化门脉高压症（portal  hypertension，PHT）出血一直是临床致力研究的课题[2]。该次于2017年10月—2018年10月间对86例肝硬化合并食管胃底静脉曲张的患者进行了随访，发现利用超声内镜监测食管壁内外及交通支曲张静脉的平均内径、平均血流速度、平均血流量等指标，能够提前预测肝硬化合并食管胃底静脉曲张破裂出血的结局，现报道如下。……