论文部分内容阅读
目的通过彩色多普勒测定胃左静脉与门静脉直径、血流速度、血流量、血流方向等血流动力学指标,探讨其预测食管静脉曲张程度与出血风险的价值。方法肝硬化门静脉高压症86例,均接受彩色多普勒、电子胃镜及肝炎标志物、肝功能等常规检验/检查。以研究对象在24个月随访期内有出血史且经内镜检查确定为食道胃底静脉曲张破裂出血为出血风险的评价标准。对比分析出血组与非出血组的胃左静脉、门静脉血流动力学特点。结果随食管静脉曲张程度的加重,胃左静脉内径呈逐渐增宽的趋势,其中食管静脉中度曲张组与无曲张组、食管静脉重度曲张组与轻度曲张组比较有显著性差异(P<0.05);门静脉内径随食管静脉曲张程度的加重渐增宽,其中食管静脉中度曲张组与无曲张组、食管静脉重度曲张组与轻度曲张组、食管静脉中度曲张组与轻度曲张组比较有显著性差异(P<0.05)。胃左静脉的离肝血流方向在出血组与非出血组间均存在显著性差异(χ2=12.049,P=0.00),这种显著性差异在Child分级的三级肝功能状态下均存在。不同肝功能状态下门静脉的离肝血流方向在出血组与非出血组间无显著性差异(P>0.05)。以胃左静脉内径6mm、门静脉内径16mm为预测食管静脉曲张出血风险分层指标,出血患者中门静脉内径≥16mm与非出血组比较存在显著性差异(χ2=4.21,P=0.04)。结论彩色多普勒测定胃左静脉血流方向、门静脉内径预测食管静脉曲张出血风险具有应用价值,在预测食管静脉曲张程度上胃左静脉、门静脉血流动力学参数均无显著价值。
Objective To evaluate the value of predicting the degree of esophageal varices and the risk of hemorrhage by color Doppler flowmetry to measure hemodynamics indexes such as gastric left venous and portal vein diameter, blood flow velocity, blood flow, blood flow direction. Methods 86 patients with cirrhosis and portal hypertension were underwent routine inspection / examination such as color Doppler, electronic endoscopy and hepatitis markers, liver function and so on. The study subjects had a history of bleeding within a 24-month follow-up period and the endoscopic diagnosis of bleeding due to esophageal and gastric variceal bleeding was the standard of care. The left ventricular and portal venous hemodynamic characteristics of the bleeding and non-bleeding groups were compared and analyzed. Results With the severity of esophageal varices, the internal diameter of gastric left ventricle was gradually broadened. There was a significant difference between moderate varicose veins and no varicose veins, mild esophageal varicose veins and mild varicose veins (P < 0.05). The diameter of portal vein increased with the severity of esophageal varices. Among them, moderate esophageal varices group and no varicose veins group, severe esophageal varices group and mild varicose veins group, mild esophageal varices group and mild varicose veins group There was significant difference (P <0.05). There was a significant difference in the left hepatic vein flow direction between the hemorrhage group and the non-hemorrhage group (χ2 = 12.049, P = 0.00). This significant difference existed in the grade 3 hepatic state with Child classification. There was no significant difference between the hemorrhagic group and the non-hemorrhagic group (P> 0.05). The gastric left venous diameter 6mm and the portal vein diameter 16mm were the stratified indexes to predict the risk of esophageal variceal bleeding. There was a significant difference (χ2 = 4.21, P = 0.04) between the diameter of the portal vein ≥16mm in the bleeding patients and the non-bleeding group. Conclusion The color Doppler flow direction of gastric left ventricle and the diameter of portal vein in predicting the risk of esophageal variceal bleeding are of great value. There is no significant value in predicting the degree of esophageal varices in left ventricular and portal vein hemodynamics.