CT门静脉造影对食管胃静脉曲张出血的应用价值

目的 探讨多排螺旋CT门静脉造影(CTPV)对食管胃静脉曲张出血的临床应用价值.方法 选择同时经胃镜及16排螺旋CT门静脉造影证实有食管胃静脉曲张的69例临床确诊为肝硬化患者,观察食管胃静脉曲张破裂出血与胃左静脉开口位置的关系,以及食管静脉曲张程度与门静脉直径的关系.结果 69例肝硬化患者应用CT门静脉造影方法 可清晰显示门静脉侧支循环血管,其中门静脉主干、胃左静脉均全部显示(100%),89.9%显示食管静脉曲张(62/69),72.5%显示胃底静脉曲张(50/69).胃左静脉开口位于门静脉主干共42例.胃左静脉开口位置与食管胃静脉曲张破裂出血之间存在相关性(X2=4.406,P<0.05);食管静脉曲张程度与门静脉直径无明显关系.结论 CT门静脉造影能很好显示门静脉高压侧支循环血管,并可对血管直径进行准确测量;胃左静脉开口在门静脉主干者易发生食管胃静脉曲张破裂出血;联合应用CT门静脉造影和胃镜检查,能对肝硬化食管胃静脉曲张严重程度及其破裂出血的危险性进行预测.     

门静脉高压该如何诊治

门静脉高压是指由各种原因导致的门静脉系统压力升高所引起的一组临床综合征.绝大多数患者由肝硬化引起,少数患者继发于布加综合征、肝窦阻塞综合征、门静脉血栓形成以及一些原因不明的因素.临床主要表现为脾大、脾功能亢进、食管胃底静脉曲张破裂出血、腹水、门静脉高压性胃病等,其中食管胃底静脉曲张破裂出血是最严重的并发症,病死率高.     

影响肝硬化患者食管静脉曲张破裂出血的危险因素分析

目的:探讨影响肝硬化患者食管静脉曲张破裂出血的相关危险因素。方法:回顾性分析2016年9月—2018年9月在我院治疗的125例肝硬化合并食管静脉曲张患者的临床资料,依据入选者食管静脉曲张有无破裂出血情况,分为对照组(食管静脉曲张未破裂出血,53例)与观察组(食管静脉曲张破裂出血,72例),分析两组患者的临床特征,并进一步进行危险因素分析。结果:两组性别、病因、肝功能Child-Pugh分级、合并消化性溃疡率、合并门静脉高压性胃病率、活化部分凝血酶原时间以及年龄对比,差异无统计学意义(P> 0. 05);观察组食管静脉曲张严重程度、腹水率、中性粒细胞、门静脉主干内径、脾静脉主干内径、脾厚度均高于对照组,血小板计数、白蛋白、胆固醇水平均低于对照组,差异有统计学意义(P <0. 05);经Logistic多因素分析,结果显示食管静脉曲张分级、门静脉主干内径与脾厚度为肝硬化患者食管静脉曲张破裂出血的危险因素(OR> 1,P <0. 05),血小板计数与白蛋白则为保护因素(OR <1,P <0. 05)。结论:食管静脉曲张分级、门静脉主干内径等为肝硬化患者食管静脉曲张破裂出血的相关危险因素,而调节白蛋白以及血小板计数利于在一定程度上减少该现象发生的风险。     

实时二维剪切波弹性成像对乙型肝炎肝硬化门静脉高压患者曲张静脉出血风险的预测价值分析

目的 探讨实时二维剪切波弹性成像技术预测乙型肝炎（乙肝）肝硬化门静脉高压患者曲张静脉出血风险的价值。方法 选取2020年1月—2022年1月武汉市中西医结合医院收治的92例乙肝肝硬化门静脉高压患者作为研究组，行实时二维剪切波弹性成像技术检查，另选取84例肝脏正常者作为对照组，比较两组肝弹性值和脾弹性值。所有乙肝肝硬化门静脉高压患者均行电子胃镜检查，并根据食管静脉曲张程度分为正常、轻度、中度和重度，比较不同程度患者的肝弹性值和脾弹性值。采用单因素分析影响乙肝肝硬化门静脉高压患者发生食管静脉曲张破裂出血的因素，采用一般多因素Logistic回归分析影响乙肝肝硬化门静脉高压患者发生食管静脉曲张破裂出血的危险因素；绘制受试者工作特征（ROC）曲线分析肝弹性值和脾弹性值对乙肝肝硬化门静脉高压患者发生食管静脉曲张破裂出血的预测价值。结果 研究组肝弹性值和脾弹性值均高于对照组（P <0.05）；不同程度食管静脉曲张患者的肝弹性值和脾弹性值比较，差异有统计学意义（P <0.05），随着食管静脉曲张程度增加，患者肝弹性值和脾弹性值逐渐升高；92例乙肝肝硬化门静脉高压患者中，共有24例发生食管静脉曲张破裂出血，发生率为26.09%（24/92）。单因素分析显示，发生食管静脉曲张破裂出血患者重度食管静脉曲张程度构成比高于未发生患者，门静脉宽度大于未发生患者，凝血酶原时间长于未发生患者，肝弹性值、脾弹性值高于未发生患者（P <0.05）；一般多因素Logistic回归分析结果显示食管静脉曲张程度［O^R=3.180（95%CI：1.037，9.757）］、肝弹性值［O^R=3.873（95%CI：1.262，11.881）］、脾弹性值［O^R=3.647（95%CI：1.189，11.189）］均是影响乙肝肝硬化门静脉高压患者发生食管静脉曲张破裂出血的危险因素（P <0.05）；ROC分析显示，肝弹性值和脾弹性值预测乙肝肝硬化门静脉高压患者发生食管静脉曲张破裂出血的最佳截断点分别为15.39 kPa和30.01 kPa，敏感性分别为83.33%（95%CI：0.626，0.953）和79.17%（95%CI：0.577，0.929），特异性分别为86.76%（95%CI：0.764，0.938）和89.71%（95%CI：0.798，0.957）（P <0.05）。结论 肝弹性值和脾弹性值对乙肝肝硬化门静脉高压患者曲张静脉出血风险具有预测价值。     

分析肝硬化门脉高压症下食管静脉曲张破裂出血的危险因素

目的分析肝硬化门脉高压症下食管静脉曲张破裂出血的危险因素。方法选取我院2011年3月至2017年3月收治的55例肝硬化门脉高压症食管静脉曲张破裂出血患者,将本组出血患者作为观察组;另取我院同期住院的55例肝硬化门脉高压症未出现食管静脉曲张破裂出血的患者作为对照组。分别对两组患者各项临床病案资料进行分析,总结影响食管静脉曲张破裂出血的各项威胁因素。结果两组患者在食管静脉曲张分级重度率、门静脉主干内径、脾静脉主干内径、脾厚度、白蛋白、血小板计数、胆固醇表现水平等指标上均存在明显差异(P0.05)。结论在对肝硬化门脉高压症患者进行临床诊断时,食管静脉曲张分级重度率、门静脉主干内径、脾静脉主干内径、脾厚度、白蛋白、血小板计数、胆固醇表现水平均可作为评价食管静脉曲张破裂出血的因素,可为后续临床治疗提供有利依据。     

中年人肝硬化并发上消化道出血29例临床护理

肝硬化门静脉高压的食管、胃黏膜病变主要包括食管胃底静脉曲张、门静脉高压性胃病和肝源性消化性溃疡.这些病变都是肝硬化患者上消化道出血的常见原因.急诊胃镜检查发现,静脉曲张破裂出血占52.4%,非静脉曲张出血占47.6%[1].现将我院收治的29例中年肝硬化并发上消化道出血的临床资料做出相关分析,报告如下.     

中西医联合对肝硬化门静脉血流动力学的影响

食管静脉曲张破裂出血是肝硬化门脉高压患者常见而凶险的并发症，死亡率高，严重威胁患者的生命。本文旨在通过彩色多普勒超声显像仪观察我院制剂虫蚁胶囊与普萘洛尔联用对肝硬化门静脉血流动力学的影响，探讨降低门静脉高压而减少食管静脉曲张破裂出血的有效治疗方法。     

增强CT扫描与超声在诊断肝硬化门脉高压食管静脉曲张破裂出血中的应用

目的分析增强CT扫描与超声在诊断肝硬化门脉高压食管静脉曲张破裂出血中的应用。方法将我院确诊且经临床病理证实为肝硬化门静脉高压的40例患者纳入研究范围,分析方式其临床资料及影像学资料,并参照消化内镜检查结果,以有无曲张静脉破裂出血暴露分组,对比门静脉主干(MPV)管径、胃左静脉(LGV)管径、计算门静脉充血指数(PV-CI)、肝静脉减振指数(HV-DI)、肝动脉渡越时间(HAAT)、肝静脉-肝动脉渡越时间(HV-HA)的差异,并采用ROC曲线分析有差异项目在肝硬化门脉高压食管静脉曲张破裂出血中的诊断价值。结果以消化内镜检查是否有食管静脉曲张破裂出血暴露分组,其中19例纳入出血组,21例纳入未出血组,经对比分析可见出血组LGV、HV-DI显著高于未出血组,HA-HA显著低于未出血组,且对比差异有统计学意义;经ROC曲线分析,LGV、HV-DI、HV-HA预测曲张静脉破裂出血的阳性阀值依次为6.00mm、0.66、5.50s,诊断敏感度依次为LGV(82.87%)﹥HV-DI(75.57%)﹥HV-HA(46.26%),诊断特异度依次为HV-HA(84.57%)﹥LGV(78.36%)﹥HV-DI(69.19%)。结论增强CT扫描与超声应用于肝硬化门脉高压食管静脉曲张破裂出血诊断时,两者在敏感度、特异度上各具优势。     

血吸虫病肝硬化食管静脉曲张破裂出血的危险因素分析

目的：探讨影响血吸虫病肝硬化食管静脉曲张破裂出血的危险因素分析。方法筛选2013年1月至2014年6月我院收治的血吸虫病肝硬化食管静脉曲张患者105例,回顾性分析影响血吸虫病肝硬化食管静脉曲张破裂出血的高危因素。结果出血组患者凝血酶原时间为（22．34±3．09）s,超声下门静脉主干内径（1．38±0.41）cm,重度食管静脉曲张31例,曲张静脉瘤样病变率达71．43％（45例）,与非出血组患者结果数据比较存在显著差异（ P＜0.05）。结论凝血酶时间延长、门静脉主干内径扩张、食管静脉曲张程度加重、曲张静脉瘤样病变均为血吸虫病肝硬化食管静脉曲张破裂出血的高危因素。     

门静脉高压的外科治疗现状及进展

传统的门静脉高压症的外科治疗主要有断流术和门体静脉分流术2大类。断流术是一类相对简便的手术,不足之处在于术后再出血率明显高于分流手术。门腔静脉侧侧分流加肝动脉强化灌注术联合术式,既能保持一定的门静脉向肝血供和提高肝动脉对肝脏的供氧量,又能疏通门静脉系统的高血流状态,故其术后并发症发生率、手术病死率和再出血率均有明显下降,疗效好。肝移植手术的出现,对彻底治愈肝硬化门静脉高压症带来了希望。但对我国大量肝炎后肝硬化、血吸虫性肝硬化并发门静脉高压症、食管胃底静脉曲张破裂出血的患者,不可能全都采用肝移植治疗。因此,传统疗法在较长时间内仍然会有用武之地。术前综合分析患者临床指标和肝功能实验室检查有助于评价肝硬化患者肝储备功能,预测手术风险及术后转归。     

Non-cirrhotic portal vein thrombosis, an uncommon cause of portal hypertension - a case report

Most cases of portal hypertension follow chronic liver disease (cirrhosis) while non cirrhotic causes are occasionally seen. A case of portal hypertension secondary to non-cirrhotic portal vein thrombosis is reported. The patient was managed at the Aminu Kano Teaching Hospital Kano, Nigeria in the year 2006. She presented with recurrent massive upper gastrointestinal bleeding and was resuscitated, followed by clinical, radiological and endoscopic evaluation. She had massive splenomegaly and grade four oesophageal varices with evidence of recent bleed. There were, however, no other stigmata of chronic liver disease or portal hypertension. Abdominal computed tomography scan confirmed portal vein thrombosis. Splenectomy and ligation of short gastric veins was performed and the patient has not had any repeat episode of haematemesis or malaena six months post surgery.     

经皮肝穿刺胃冠状静脉栓塞术治疗肝硬化合并门静脉高压症的临床应用

目的：探讨经皮肝穿刺食管胃底静脉栓塞术治疗肝硬化门静脉高压食管胃底静脉曲张破裂出血的临床应用。方法：自2009年起,我科对15例肝硬化门静脉高压食管胃底静脉曲张患者采用经皮肝穿刺胃底食管静脉栓塞或联合脾动脉部分栓塞术预防和控制上消化道出血。结果：经皮肝穿刺食管胃底静脉栓塞手术成功率100%,止血率达100%。术后死亡1例,分析原因为急性肺动脉栓塞,术后11例患者出现低热症状,5~7 d后缓解,部分患者术后出现轻度腹痛症状,对症止痛治疗后症状逐渐缓解。除1例患者术后考虑为急性肺栓塞死亡外,未出现肝脏出血、感染、门静脉血栓、肝功能衰竭等并发症。14例患者随访4~10个月,再发消化道出血1例,因肝肿瘤进展死亡4例。结论：经皮肝穿刺胃冠状静脉栓塞技术是一种微创、有效的方法。但是术者在术前及术中需重视对患者血流动力学改变的分析,术中注意观察患者有无大的分流道的存在,并选择合适的栓塞材料。     

Percutaneous transjugular portosystemic shunt

OBJECTIVE.--To determine the effectiveness of the Palmaz balloon expandable stent for the creation of a transjugular intrahepatic portosystemic shunt. The device is designed to achieve portal decompression in patients with variceal hemorrhage secondary to portal hypertension. DESIGN.--Transjugular intrahepatic portosystemic shunting was performed in eight patients during a 9-month period. Mean follow-up was 5 months. PATIENTS.--All patients had cirrhosis with portal hypertension and varices. Bleeding occurred in seven patients from esophageal varices and in one patient from hemorrhoids. MAIN OUTCOME MEASURES.--Shunt patency and recurrent variceal hemorrhage. RESULTS.--Shunts created from a transjugular approach between a hepatic and a portal vein (diameters of 8 to 12 mm) lowered the average portosystemic pressure gradient from 36 to 11 mm Hg. Mean postoperative hospital stay was 7.7 days. Complete variceal decompression after transjugular intrahepatic portosystemic shunt placement was identified endoscopically in all eight patients. The patient treated for hemorrhoids rebled and was treated successfully by transfemoral balloon expansion of the shunt diameter from 8 to 12 mm. All shunts were patent at 1 to 9 months (mean, 5 months) of follow-up. CONCLUSION.--Initial results suggest that transjugular intrahepatic portosystemic shunt is a safe and effective method of portal decompression for the treatment of variceal hemorrhage.     

胃冠状静脉栓塞联合脾栓塞治疗肝硬化消化道出血

目的 探讨经皮经肝胃冠状静脉栓塞(PTVE)联合选择性脾红髓小动脉栓塞(PSAE)治疗肝硬化消化道出血的疗效. 方法 26例肝硬化、门静脉高压并胃底静脉重度曲张出血的患者,经皮经肝穿刺门静脉,造影后找到胃冠状静脉、胃短静脉,并栓塞该静脉;再择期行选择性脾红髓栓塞,以降低门静脉压力、缓解脾功能亢进.并术后随访15月,同时胃镜复查. 结果 术后26例患者当时急性出血均被控制,术后造影示胃冠状静脉、胃短静脉闭塞,随访期间,22例(84.62％)患者上消化道出血症状消失,19例(73.08％)胃底静脉曲张完全消失,3例(11.54％)胃底静脉曲张复发,4例(15.38％)再发食道胃底破裂出血.但所有患者脾功能亢进症状均明显改善.结论 经皮经肝胃冠状静脉栓塞联合选择性脾红髓小动脉栓塞治疗肝硬化消化道出血,不但可以控制消化道出血,还可以降低门静脉压力,缓解脾功能亢进,且复发率低,长期疗效确切.值得推广.     

Treatment of portal hypertension from portal vein cavernoma with the meso-Rex bypass

Extrahepatic or prehepatic portal vein cavernoma and thrombosis is a more common condition in children than that in adult patients with extrahepatic or prehepatic portal vein obstruction (EHPVO),which involves approximately 30％ of children with portal hypertension and can involve all the portal hypertension complications.Cavernomatous transformation of the portal vein is common after portal thrombosis in non-cirrhotic patients.This challenging situation is relatively more frequent after liver transplantation,particularly in pediatric recipients.Acute bleeding from esophageal and gastric varices is temporarily treated by sclerotherapy or variceal banding.     

Chronic portal vein thrombosis due to combined deficiency of protein C and protein S

Portal vein thrombosis (PVT) is a rare disorder that is associated with a variety of underlying condition of which liver cirrhosis, malignancy and myeloproliferative disorders are the most common. It is of two types, acute and chronic portal vein thrombosis. Anticoagulation therapy is recommended for all patients with acute portal vein thrombosis. Chronic portal vein thrombosis is characterised by the development o f portal hypertension. Bleeding from ruptured varices is the main complication. In the absence of bleeding, continuous anticoagulation therapy should be considered for chronic portal vein thrombosis in whom an underlying prothrombotic factor is to be identified. Here in this report a 13-year-old girl presented with haematemesis. The spleen was hugely enlarged. Her Hb was 8.38 g/dl. Grade III oesophageal varices were found in oesophagogastroduodenostomy. CT abdomen showed portal cavernoma formation with increased splenic collateral. Protein C activity was 45% and protein S activity was 40%. She was treated with beta-blocker, endoscopic variceal ligation followed by low molecular weight heparin and warfarin.     

血管内栓塞治疗脾动静脉瘘所致的消化道大出血1例

Splenic arteriovenous fistula-caused gastrointestinal bleeding is rare. We report a patient who had splenectomy and partial pancreatectomy history due to trauma presented with portal hypertension manifested by variceal bleeding with no evidence of liver disease. Celiac trunk arteriography confirmed the bleeding caused by splenic arteriovenous fistula. We successfully achieved hemostasis by occluding the fistula with embolization coils, demonstrating that endovascular embolization is an effective treatment for splenic arteriovenous fistula-caused gastrointestinal bleeding.     

彩色多普勒超声对预防性EVL后疗效的研究

目的:探讨肝硬化Child-Pugh A级患者预防性经内镜食道曲张静脉套扎(EVL)对门静脉血流量和肝功能的影响及其相关性。方法:对16例Child-Pugh A级患者食道曲张静脉行预防性EVL,套扎前后采用彩色多普勒超声对门静脉血流参数定量测定,并结合肝功能指标的变化进行分析。结果:门静脉血流量由套扎前的994.86±175.03mL/min升高至套扎后三个月的1070.45±217.61mL/min和六个月的1074.93±224.09mL/min,患者血清白蛋白浓度、总胆固醇浓度以及血浆凝血酶原时间均较套扎前显著改善;门静脉血流量的增加同上述肝功能指标的改善,呈显著直线相关。结论:彩色多普勒超声可以准确评价EVL术前后门静脉血流参数的变化,预防性EVL可以通过增加门静脉血流改善Child-Pugh A级患者的肝功能。     

经颈内静脉肝内门体分流术并胃冠状静脉栓塞术治疗门脉高压症疗效的超声评价

目的探讨经颈内静脉肝内门体分流术(TIPSS)并胃冠状静脉栓塞术(GCVE)治疗肝硬化门静脉高压症的临床疗效.方法用彩色多普勒超声对13例行TIPSS并GCVE的门静脉高压患者进行血流动力学及腹水情况的跟踪观察.结果13例随访12个月以上,平均(14.0±1.5)个月,13例首次置管全部成功,1例7个月后因分流道狭窄、上消化道出血再次入院,分流道通畅率92.31%(12/13).结论TIPSS并GCVE联合运用能有效治疗门静脉高压症所致上消化道出血和腹水.