奥曲肽治疗食管胃底静脉曲张破裂临床观察

食管胃底静脉曲张是肝硬化患者门静脉高压的一种临床表现,破裂后易引起上消化道大出血危及生命。近2 a来我院对肝硬化并发食管胃底静脉曲张破裂出血患者,在常规治疗基础上,给予奥曲肽治疗,收到了良好的疗效。现报告如下。1对象和方法1.1对象本组男15例,女7例,年龄35～70(平均51.5)岁。均经超声诊断为肝硬化并门静脉高压,胃镜下可见食管胃底静     

食管胃底静脉曲线破裂出血的治疗对肝脏血液灌注的影响

门静脉高压症是一种由多种病因引起的门静脉系统血液动力学紊乱的临床综合征 ,而食管胃底静脉曲张是门静脉高压症的严重并发症之一 ,在门静脉高压的病因中符合“后向血流”学说的以肝硬化为多见。本研究对肝硬化并门脉高压症的病人发生食管胃底静脉曲张破裂出血时 ,在相关因素作用下 ,肝脏血液灌注的情况进行观察。1　资料与方法1 1　选取 1 992～ 1 998年间我院住院的上消化道出血的患者 ,经紧急胃镜检查确诊为食道胃底静脉曲张破裂出血的患者 ,Ｂ超检查符合肝硬化诊断标准 ,既往无上消化道出血病史 ,共 64例 ,其中男 53例 ,女 1 1例 ,年…     

PTVE治疗食管胃底静脉曲张破裂出血20例临床分析

目的：观察经皮经肝食管胃底曲张静脉栓塞术（阴VE）治疗食管胃底静脉曲张破裂出血的临床疗效。方法：对20例急性食管胃底静脉曲张破裂出血的患者进行nVE治疗。结果：20例患者PTVE术后能即刻止血,成功率100％,3d～3个月后,4例患者发生再出血。PTVE术后3周,血清白蛋白明显升高。结论：急诊门VE创伤小、禁忌证少,既控制了上消化道出血,又保持了门静脉的适度压力,起到了保护肝功能的作用,是食管胃底静脉曲张破裂出血的有效治疗方法。     

食管胃底静脉曲张破裂出血的治疗对肝脏血液灌注的影响

门静脉高压症是一种由多种病因引起的门静脉系统血液动力学紊乱的临床综合征,而食管胃底静脉曲张是门静脉高压症的严重并发症之一,在门静脉高压的病因中符合"后向血流"学说的以肝硬化为多见.本研究对肝硬化并门脉高压症的病人发生食管胃底静脉曲张破裂出血时,在相关因素作用下,肝脏血液灌注的情况进行观察. 1 资料与方法 1.1 选取1992～1998年间我院住院的上消化道出血的患者,经紧急胃镜检查确诊为食道胃底静脉曲张破裂出血的患者,B超检查符合肝硬化诊断标准,既往无上消化道出血病史,共64例,其中男53例,女11例,年龄42～58岁,肝炎后肝硬化59例,酒精性肝硬化5例,合并肝癌2例,符合Pugh改良肝功能分级B级12例,C级52例.     

垂体后叶素和奥曲肽治疗肝硬化合并EVB患者的临床效果研究

<正>肝硬化是一种较为常见的消化道疾病,其发病率较高[1]。肝硬化的并发症较多,其中上消化道出血是最为严重的并发症之一,而出血原因有很多,如肝源性溃疡、食管胃底静脉曲张破裂、门静脉高压性胃病、异位静脉曲张等都可导致患者上消化道出血,其中肝硬化伴食管胃底静脉曲张破裂(EVB)者较为常见[2]。目前临床上多采用药物止血的方式对肝硬化合并EVB患者进行治疗,常用的药物为垂体后叶素,但用药量较大会导     

内镜止血技术在上消化道出血中的临床实践

<正>上消化道出血是消化内科常见急症之一,包括非静脉曲张性出血和静脉曲张性出血。非静脉曲张性出血是指血管畸形、上消化道黏膜炎症、消化性溃疡、上消化道肿瘤等消化道非静脉曲张破裂引起的出血,主要出血部位包括胰胆管、胃十二指肠、食管等;静脉曲张性出血是指由于肝门静脉高压导致胃底静脉、食管静脉从等曲张,血压上升或进食致静脉破裂而引发出血[1-2]。临床中,上消化道出血常采取止血、扩容及抑制胃酸、保护胃     

肝硬化合并上消化道出血的危险因素分析与护理对策

目的探讨影响肝硬化合并上消化道出血患者的危险因素与针对性护理对策。方法选取2015年1月至2017年6月我院接治的80例肝硬化患者作为研究对象,对其临床资料进行回顾性研究,根据有无合并上消化道出血分成观察组和对照组,分析和总结肝硬化合并上消化道出血的危险因素并探讨相应的护理对策。结果肝硬化病程、凝血酶原时间(PT)≥16 s、肝功能分级、食管静脉曲张度、胃底静脉曲张、腹水门静脉高压、不良生活习惯是肝硬化合并上消化道出血的主要因素(P0.05);通过多因素logistic回归分析,表明肝硬化病程、PT≥16 s、食管静脉曲张程度、胃底静脉曲张及门静脉高压是独立风险因素(P0.05)。结论影响肝硬化合并消化道出血的原因较多,应加强针对性护理干预,提升临床效果,促进患者康复。     

肝硬化门静脉高压食管胃静脉曲张出血的防治

肝硬化是门静脉高压的最常见病因,而食管胃底静脉曲张出血是门静脉高压的致死性临床表现,需积极预防。食管胃底静脉曲张出血预防的目的:防止未出血的肝硬化患者静脉曲张形成和进展;对于中重度静脉曲张者预防出血;对于有出血史者,防止再次出血     

食管胃底静脉破裂出血病人的观察和护理

肝硬变伴肝内门静脉梗阻和门静脉高压是引起食管、胃底静脉曲张破裂出血的最常见原因［１］。食管、胃底静脉曲张并发破裂出血,其出血量大,危及生命。我科自从１９９３年４月～１９９６年１２月共收治门静脉高压症并发食管、胃底静脉曲张破裂出血２０例。现将急救与护理...     

脾切除加贲门周围血管离断术治疗肝硬化门静脉高压症132例

肝硬化门静脉高压症常引起食管胃底静脉曲张破裂出血、脾脏肿大、脾功能亢进、腹水及肝性脑病等。而上消化道出血常常是肝硬化患者死亡的主要原因。我院普外科自1993年6月至2008年12月共收治肝硬化、门静脉高压症132例,     

肝硬化食管静脉曲张程度门脾静脉内径及Child-Pugh分级的关系

目的 探讨肝硬化食管静脉曲张程度与门脾静脉内径、肝功能Child-Pugh分级间的关系.方法 对2007年1月-2010年1月间56例肝硬化患者行增强CT,测量门静脉主十及脾门部脾静脉直径,采用Child-Pugh分级标准进行肝功能分级,并行胃镜了解食管静脉曲张的程度.结果 食管静脉曲张程度与门、脾静脉内径呈正相关,而...     

Traitement des complications de l’hypertension portale par TIPS en 2016

Portal hypertension (PHT) is defined by an increase of the pressure gradient between the sus-hepatic vena and the portal vein. PHT is most often due to liver cirrhosis. Transjugular intrahepatic portosystemic shunt (TIPS) is a percutaneously created low-resistance channel between the portal and the hepatic veins. The goal of TIPS is to reduce portal pressure by shunting blood from the portal to the systemic circulation, bypassing the liver. TIPS could permit to treat severe portal hypertension-related complication such as esophageal or gastric varices bleeding. TIPS is currently indicated as the salvage therapy in patients with bleeding esophageal varices who failed to respond to standard treatment. More recently, applying TIPS early has been shown to be an effective treatment to control bleeding and decrease mortality in patients with severe cirrhosis. TIPS is also recommended as the second-line treatment for secondary prophylaxis. TIPS is a promising treatment for refractory ascites or hepatic hydrothorax. TIPS should be considered in the treatment of Budd-Chiari syndrome. However, the role of TIPS in the treatment of hepatorenal syndrome is not well defined.     

Isolated gastric varices: Splenic vein obstruction or portal hypertension?

The presence of isolated gastric varices without esophageal varices is thought to be highly suggestive of splenic vein obstruction. A review of our radiologic files revealed 14 patients with isolated gastric varices on barium studies performed during the past 10 years. Eight of the 14 patients had adequate clinical and/or radiologic follow-up to suggest the pathophysiology of the varices. Seven had evidence of portal hypertension, and the remaining patient had evidence of splenic vein obstruction. Six patients had signs of upper gastrointestinal (GI) bleeding. Double-contrast upper GI examinations revealed thickened, tortuous fundal folds in 6 patients and a lobulated fundal mass in 2. Thus, most patients with isolated gastric varices have portal hypertension rather than splenic vein obstruction as the underlying cause.     

肝硬化食管静脉曲张破裂出血患者门静脉血流参数的变化

目的 探讨彩色多普勒超声预测肝硬化门静脉高压症(cirrhotic portal hypertension)患者食管静脉曲张破裂出血的应用价值.方法 肝硬化门静脉高压症患者81例,根据有无出血史分为出血组(36例),非出血组(45例).应用彩色多普勒超声分别检测两组的门静脉(pv)和脾静脉(sv)内径(Dpv、Dsv)、血流动力学参数并进行对比分析.结果 门静脉和脾静脉的内径、血流速度(Vpv、Vsv)及脾静脉的血流量(Qsv)在两组间差异均有统计学意义(P<0.05),但门静脉血流量(Qpv)在两组间差异无统计学意义(P>0.05).结论 彩色多普勒超声检测肝硬化门静脉高压症患者门静脉和脾静脉内径及血流动力学参数,对预测肝硬化门静脉高压时食管静脉曲张破裂出血是有价值的.     

胃底静脉曲张出血33例临床分析

目的 分析胃底静脉曲张出血的病因、诊断和治疗方法。方法 回顾分析该院1994年元月～2003年12月检查确诊为胃底静脉曲张出血33例，对其临床资料进行分析讨论。结果 病因：肝硬化门脉高压23例，肝癌6例，脾静脉阻塞4例。治疗结果：内镜下套扎17例；5例于1～3d内复发大出血死亡，另有9例2个月内复发出血，硬化剂治疗4例，均有复发出血；17例行手术治疗，14例术后无再出血，3例虽有复发出血，但频率及出血量明显减少。结论 胃底静脉曲张是门脉高压，特别是脾胃区门脉高压的表现。胃底静脉曲张较食管静脉曲张出血率低，但出血更严重。内镜对胃底静脉曲张的诊断价值有限。对胃底静脉曲张不宜行套扎或硬化剂治疗。能手术者应首选手术治疗，不宜手术者可考虑介入治疗，栓塞胃底静脉。     

脾脏长径在无创性预测肝硬化高危食管曲张静脉出血中的临床价值

目的 研究门静脉、脾静脉内径和脾脏长径与肝硬化高危食管静脉曲张的关系及其临床价值.方法 回顾性分析望江县人民医院78例肝硬化合并食管静脉曲张住院患者的临床资料.出血组38例,非出血组40例.所有患者均行内镜确诊为食管静脉曲张.收集患者的一般资料、病因、Child-Pugh分值、肝功能生化指标（凝血酶原时间、白蛋白和胆红素水平）、是否出现腹水情况、是否有红色征,B超检测肝门静脉内径、脾静脉内径和脾脏直径.结果 两组间在红色征、肝门静脉内径、脾静脉内径和脾脏直径方面差异均有统计学意义（P均〈0.05）,出血组明显高于非出血组.结论 肝硬化食管静脉曲张破裂出血患者门静脉、脾静脉内径和脾脏长径明显增高,作为一种无创性检查指标,脾脏长径对于高危食管曲张静脉的诊断有一定的预测价值,有助于早期识别需行一级预防的肝硬化患者.     

Sinistral portal hypertension; imaging findings and endovascular therapy

Sinistral portal hypertension, a rare and localized form of portal hypertension, is the result of splenic vein thrombosis or obstruction and may cause gastrointestinal hemorrhages from the esophageal and gastric varices. This report presents two cases (69- and 10-year-old females) of bleeding gastric varices. The patients were diagnosed as having sinistral portal hypertension. Splenic artery embolization was performed in both patients to overcome intractable bleeding, and the clinical outcome was good.     

A case of non-cirrhotic portal hypertension associated with anti-retroviral therapy in a Japanese patient with human immunodeficiency virus infection

The diagnosis of non-cirrhotic portal hypertension (NCPH), a rare but potentially life-threatening complication in human immunodeficiency virus (HIV)-positive individuals, often occurs only after the emergence of fatal manifestations such as bleeding of esophageal varices. We herein report a female Japanese HIV patient who developed NCPH approximately 4 years after discontinuation of 65 months of didanosine (ddI) administration. The patient presented with severe ascites, bloody bowel discharge, extreme abdominal swelling, and symptoms of portal hypertension but no sign of liver cirrhosis. Examination revealed esophageal varices, oozing-like bleeding from a wide part of the colon, significant atrophy of the right lobe of the liver, and arterio-portal shunting and recanalization from the left medial segment branch of the portal vein to a paraumbilical vein, but no visible obstruction of the main trunk of the portal vein. Treatment for esophageal varices consisted of coagulation therapy with argon plasma after enforcement by endoscopic sclerotherapy and oral administration of β-blockers for elevated portal blood pressure. The patient has not experienced gastrointestinal bleeding in the approximately 5 years since the diagnosis of NCPH. Reviewing this case suggests the importance of suspecting NCPH in HIV patients with liver dysfunction of unknown etiology with a history of ddI and other purine analogs use, as well as the importance of controlling portal hypertension and esophageal varices in the treatment of NCPH.     

肝硬化食管胃静脉曲张的内镜治疗

肝硬化食管胃静脉曲张出血是危及生命的门脉高压并发症。食管静脉曲张一级预防策略为非选择性β受体阻滞剂（non selective beta blockers,NSBBs）或内镜下静脉曲张套扎术（endoscopic variceal ligation,EVL）,急性出血时首选EVL,其二级预防推荐NSBBs联合EVL。胃静脉曲张出血中,食管胃静脉曲张1型（gastroesophageal varices type 1,GOV1）应用EVL,食管胃静脉曲张2型（gastroesophageal varices type 2,GOV2）和孤立胃静脉曲张（isolated gastric varices,IGV）推荐内镜下组织胶注射术。预防胃静脉曲张再出血方面,内镜下组织胶注射术和经颈静脉肝内门体分流术（transjugular intrahepatic portosystemic shunt,TIPS）可应用于GOV2型和IGV,EVL、NSBBs或内镜下组织胶注射术可应用于GOV1型。胃静脉曲张一级预防可选用NSBBs或内镜下组织胶注射术。     

内镜套扎联合部分脾栓塞术治疗门脉高压症及其对血流动力学的影响

目的 :探讨一种新的治疗门脉高压症的手术方法。方法 :对 41例合并食管静脉曲张和脾功能亢进的门脉高压症患者实施内镜套扎 -部分脾栓塞联合治疗 ,手术前后采用彩色多普勒超声检查门奇静脉侧支循环情况 ,与对照组进行对比研究。结果 :除 1例患者出现异位栓塞死亡 ,1例出现脾脓肿经开腹手术治疗得到治愈外 ,未发生其他严重并发症。联合术后患者食管曲张静脉得到根治 ,脾功能亢进缓解。手术后患者门静脉血流速度减慢 ,血流量减少 (P <0 .0 5) ,奇静脉血流量降低 (P <0 .0 1 ) ,胃左静脉血流速度减慢 (P <0 .0 5)。术后随访 2～ 2 4个月 ,未出现复发性出血。结论 :联合术能有效地治疗门脉高压症食管静脉曲张出血和脾功能亢进 ,减少了闭塞曲张静脉所需重复套扎次数及近期再出血 ,同时术后减少了门静脉血流速度 ,血流量 ,降低了套扎术后复发出血的风险 ,该方法操作简单 ,侵袭性小 ,尤其适应于肝功能较差 ,难以耐受分流及断流手术的门脉高压症患者。