食管曲张静脉无创测压

食管曲张静脉压力测定是预测食管曲张静脉出血的最主要因素,食管曲张静脉的压力可在内镜下测定。Palmer于1951年首次报道静脉内测压,1982年瑞士学Monismann利用呼吸压力测定原理进行仞管曲张静脉血管外测压,该方法不断改进,无创测压与直接穿刺测压的比较研究发现两有极好的直线相关关系。目前,无创性食管曲张静脉测压研究仍处于实验室阶段,尚未获得公认,其原因在于难以消除血管壁张力的贴壁测压的影响。     

食管曲张静脉无创测压

食管曲张静脉压力测定是预测食管曲张静脉出血的最主要因素 ,食管曲张静脉的压力可在内镜下测定。 Palm er于195 1年首次报道静脉内测压 ,1982年瑞士学者 Monismann利用呼吸压力测定原理进行食管曲张静脉血管外测压。该方法不断改进 ,无创测压与直接穿刺测压的比较研究发现两者有极好的直线相关关系。目前 ,无创性食管曲张静脉测压研究仍处于实验室阶段 ,尚未获得公认 ,其原因在于难以消除血管壁张力对贴壁测压的影响     

晚期血吸虫病食管静脉曲张破裂不同出血量套扎术的治疗效果

目的探讨在不同出血量及肝功能状态下,食管曲张静脉套扎术（EVL）治疗食管曲张静脉破裂（EVB）出血的临床治疗效果。方法选择湘岳医院2005年1月至2010年12月收治的晚期血吸虫病并发EVB患者107例,在内科综合治疗基础上给予EVL。结果本组患者107例,肝功能Child分级与食管曲张静脉程度有等级相关关系,相关系数为0.728（P〈0.01）,与出血量呈正相关关系,相关系数为0.848（t=16.426,P〈0.01）。内科治疗＋套扎术治疗的有效率为97.87%,单纯内科治疗的有效率仅为12.15%,二者比较差异有统计学意义（P〈0.01）。结论肝功能损害越严重食管胃底静脉曲张程度就越大、出血量也越多。内科治疗＋套扎术治疗EVB的有效率明显优于单纯内科治疗。     

基于计算机视觉的无创性食管曲张静脉测压仪

无创性食管曲张静脉测压是当前的一个研究热点,我们提出了一种基于计算机视觉的食管曲张静脉测压方法,实验表明该方法能准确快速的测量食管曲张静脉压力。     

门脉断流术在肝硬化胃底食管下段静脉曲张破裂出血患者的疗效观察

目的 在对肝硬化胃底食管下段静脉曲张破裂出血的患者进行治疗时应用门脉断流术,并对其临床治疗效果进行观察与分析.方法 选取自2014年7月～2015年1月在我院进行治疗的肝硬化胃底食管下段静脉曲张破裂出血的患者共计32例,在征得患者及其家属的同意之后对其进行临床实践与研究,患者使用门脉断流术对自身疾病进行治疗,由护理人员对患者提供优质的护理服务并对患者的临床治疗效果进行观察.结果 经过手术后,有8例患者死亡,死亡率为25％,其中有6例患者临床检测为由于肝功能衰竭而死亡,另2例患者则在术后两年左右去世.结论 在临床对肝硬化胃底食管下段静脉曲张破裂出血的患者进行治疗时,使用门脉断流术的治疗方法有着相对较为理想的治疗效果,值得对其进行应用并大力的推广.     

食管胃底曲张静脉栓塞加脾动脉栓塞法治疗急诊肝硬化上消化道大出血

目的探讨应用经皮经肝食管胃底曲张静脉栓塞(PTVE)联合经皮部分性脾动脉栓塞(PSE)治疗肝硬化门脉高压所致的急诊上消化道大出血的有效性和安全性。方法回顾性分析36例肝硬化门脉高压(不合并肿瘤者)所致的急诊上消化道大出血患者,均急诊行NBCA胶加弹簧圈栓塞食管胃底曲张静脉治疗,再于一周后行部分性脾动脉栓塞术,分析36例病例的近期疗效(6~18月)、并发症,评价该方法的有效性和安全性。结果36例病例均应用NBCA胶和弹簧圈栓塞食管胃底曲张静脉,术中术后未出现重大手术并发症,术后跟踪随访6~24月,有4例患者出现上消化道出血复发,其中1例患者复发出现在介入栓塞后的第二天,再次行栓塞治疗后好转,余3例患者复发的上消化道出血均不严重,经内科保守治疗后恢复。结论NBCA胶配合弹簧圈栓塞食管胃底曲张静脉治疗肝硬化门脉高压所致的上消化道出血是有效的安全性,加用部分性脾动脉栓塞术可降低门静脉压力,提高单纯性食管胃底曲张静脉栓塞的疗效。     

套扎术联合中药抗纤维化预防上消化道出血远期疗效观察

目的 通过观察食管、胃底曲张静脉套扎术联合抗纤维化中成药物去纤软肝胶囊预防曲张静脉破裂出血的远期效果,探索治疗食管、胃底静脉曲张破裂出血的有效方法.方法 将我院收治的肝硬化并发急性上消化道出血的150例患者分成3组,第一组口服心得安,第二组采用套扎术联合口服心得安,第三组采用套扎术联合心得安及去纤软肝胶囊,在不同时间段内观察再出血发生率.结果 第三组患者在出血停止后15天、1个月内,再出血发生率与前两组比较无明显差异,但在6个月和1年后,再出血发生率明显低于前两组.结论 套扎术联合口服心得安及去纤软肝胶囊能有效降低再出血发生率,值得临床推广.     

急诊断流术治疗门脉高压并上消化道出血的研究进展

食管胃底曲张静脉破裂大出血是门脉高压症(门脉高压)的严重并发症,出血来势凶猛,量大,病情危急,迅速有效的止血是改善病人预后的关键.手术治疗是门静脉高压症食管胃底曲张静脉破裂大出血的主要治疗方法,主要有三种:即断流、分流和减少,其术式有数十种之多.本文就断流术治疗门脉高压并上消化道出血的进展做一综述.     

胃底,贲门及食管区静脉的应用解剖

观测了１００例成年尸体胃底，贲门及食管区静脉。结果显示：胃左，右静脉的出现率分别是９６％和９２％，在胃小弯侧的配布可归纳为五种类型，即胃左静脉型，胃右静脉型，胃左静脉优势型，胃右静脉优势型和胃左，右静脉均衡型。胃后静脉出现率为７３．６％，多数汇入脾静脉左１／３段。此外还发现胃左静民左膈下静永脉间有相对恒定的吻合。文章最后讨论了门奇静脉断流术时可能造成流不彻底的解剖因素。     

经皮穿肝曲张静脉栓塞术联合部分脾栓塞术治疗食管胃底静脉曲张破裂出血的临床应用

食管胃底静脉曲张破裂出血是肝硬化门静脉高压常见的并发症,来势凶猛,出血量大,病死率高,静脉套扎及硬化剂治疗效果不满意,短期出血率较高。单纯经皮穿肝曲张静脉栓塞术（percutaneoustranshe—paticvaricealembolization,PTVE）急性止血效果好,但术后复发出血率高．远期疗效不理想。为此,笔者在既往PTVE基础上．联合部分脾栓塞术治疗胃底静脉曲张破裂出血,取得了良好的治疗效果,现报道如下。     

内镜下食管胃静脉曲张精准断流术疗效观察

目的:观察内镜下食管胃静脉曲张精准断流术（ESVD）的疗效。 方法:选取2017年1月至2017年8月钦州市第一人民医院收治的门脉高压食管胃静脉曲张破裂出血患者80例为研究对象,依照患者入院顺序将其分成两组,每组40例。对照组给予内镜下套扎术治疗,观察组在内镜下实施ESVD术,记录两组手术一般情况及食管胃静脉曲张改善情况,并对比两组治疗后6个月内再出血率及并发症发生率。 结果:两组患者手术一般情况比较无显著差异（P>0.05）;观察组治疗有效率为85.00%,高于对照组的55.00%（P<0.05）;术后3、6个月观察组再出血率5.00%、10.00%,明显低于对照组的30.00%、40.00%（P<0.05）;术后6个月与对照组相比,观察组患者并发症发生率偏低,但无显著差异（P>0.05）。 结论:对门脉高压食管胃静脉曲张破裂出血患者在内镜下实施ESVD术后近期疗效较好,可促进患者恢复,远期疗效有待进一步观察。     

内镜下套扎术联合药物治疗食管静脉曲张出血的近期疗效观察

目的探讨内镜下食管静脉曲张套扎术联合药物治疗肝硬化上消化道出血的近期疗效。方法回顾性分析2007年3月至2009年12月143例肝硬化患者行食管静脉曲张套扎术治疗的资料。结果食管静脉曲张套扎术术后联合普奈洛尔、抑酸剂、生长抑素等药物治疗,明显降低早期再出血、食管溃疡、门脉高压性胃病等发生率;肝功能C级患者再出血率明显高于A级及B级患者;肝硬化有脾切除加断流术史者与无脾切除加断流术患者比较,食管静脉曲张复发率低。结论食管静脉曲张套扎术术后联合药物治疗可降低食管静脉曲张复发、食管静脉曲张出血早期再发率,减少食管溃疡、门脉高压性胃病发生率。食管静脉曲张套扎术是治疗食管静脉曲张出血安全有效的方法,疗效确切,提高了患者生存率。     

食管贲门癌术后胸内吻合口及胸胃瘘的临床处理

目的探讨食管癌、贲门癌切除术后胸内吻合口及胸胃瘘的合理治疗方法。方法回顾1369例食管癌、贲门癌切除术后病人的临床资料，总结胸内吻合口瘘及胸胃瘘的正确处理方法。结果全组共发生胸内吻合口及胸胃瘘25例，其中吻合口瘘19例，胸胃瘘6例，总发生率为2．0％，死亡率为28．0％。行保守治疗19例，死亡5例，死亡率为26．3％；行二次开胸6例，死亡2例，死亡率为33．3％。结论胸内吻合口。瘘及胸胃瘘是食管重建术后严重的并发症，综合应用静脉高价营养和胃肠内营养等治疗手段是处理胸内瘘的有效的保守治疗方法。     

The roles of connective tissue growth factor in the development of anastomotic esophageal strictures

Introduction

The aim of this study was to investigate the roles of connective tissue growth factor (CTGF) in the development of anastomotic strictures after surgical repair of the esophagus.

Material and methods

Tissues collected from the patients were divided into three groups based on the results of endoscopy and clinical grading. Patients without dysphagia after esophagectomy were used as the control population. The protein levels of CTGF, TGF-β1, Smad2, and Smad4 were determined by immunohistochemistry (IHC) and western blot analyses, while the mRNA levels of the two growth factors were evaluated by real-time polymerase chain reaction.

Results

Compared with the control group, significantly increased (p < 0.01) levels of CTGF and TGF-β1 protein were observed in the anastomotic stenosis (AS) group, and levels of the two proteins detected by the IHC and western blot analyses were also significantly increased with the increasing severity of stenosis (p < 0.05). The mRNA levels of CTGF and TGF-β1 in the tissues collected from the patients with stenosis were significantly up-regulated (p < 0.05) as compared with those from the control group. In addition, the levels of Smad2 and Smad4 protein were also significantly increased (p < 0.05) with the increasing severity of stenosis, and the protein levels were positively correlated with the levels of CTGF (r = 0.59, p < 0.05) and TGF-β1 (r = 0.63, p < 0.05).

Conclusions

Inhibition of CTGF protein or mRNA expression may be a distinctive and effective therapy for the treatment of postoperative anastomotic strictures.     

Prediction of large esophageal varices in cirrhotic patients using classification and regression tree analysis

OBJECTIVES:

Recent guidelines recommend that all cirrhotic patients should undergo endoscopic screening for esophageal varices. That identifying cirrhotic patients with esophageal varices by noninvasive predictors would allow for the restriction of the performance of endoscopy to patients with a high risk of having varices. This study aimed to develop a decision model based on classification and regression tree analysis for the prediction of large esophageal varices in cirrhotic patients.

METHODS:

309 cirrhotic patients (training sample, 187 patients; test sample 122 patients) were included. Within the training sample, the classification and regression tree analysis was used to identify predictors and prediction model of large esophageal varices. The prediction model was then further evaluated in the test sample and different Child‐Pugh classes.

RESULTS:

The prevalence of large esophageal varices in cirrhotic patients was 50.8%. A tree model that was consisted of spleen width, portal vein diameter and prothrombin time was developed by classification and regression tree analysis achieved a diagnostic accuracy of 84% for prediction of large esophageal varices. When reconstructed into two groups, the rate of varices was 83.2% for high‐risk group and 15.2% for low‐risk group. Accuracy of the tree model was maintained in the test sample and different Child‐Pugh classes.

CONCLUSIONS:

A decision tree model that consists of spleen width, portal vein diameter and prothrombin time may be useful for prediction of large esophageal varices in cirrhotic patients.     

Clinical outcomes of balloon-occluded retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage in Korean patients with liver cirrhosis: a retrospective multicenter study

Background/Aims

This study evaluated the clinical outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) for the treatment of hemorrhage from gastric varices (GV) in Korean patients with liver cirrhosis (LC).

Methods

We retrospectively analyzed data from 183 LC patients who underwent BRTO for GV bleeding in 6 university-based hospitals between January 2001 and December 2010.

Results

Of the 183 enrolled patients, 49 patients had Child-Pugh (CP) class A LC, 105 had CP class B, and 30 had CP class C at the time of BRTO. BRTO was successfully performed in 177 patients (96.7%). Procedure-related complications (e.g., pulmonary thromboembolism and renal infarction) occurred in eight patients (4.4%). Among 151 patients who underwent follow-up examinations of GV, 79 patients (52.3%) achieved eradication of GV, and 110 patients (72.8%) exhibited marked shrinkage of the treated GV to grade 0 or I. Meanwhile, new-appearance or aggravation of esophageal varices (EV) occurred in 54 out of 136 patients who underwent follow-up endoscopy (41.2%). During the 36.0±29.2 months (mean±SD) of follow-up, 39 patients rebled (hemorrhage from GV in 7, EV in 18, nonvariceal origin in 4, and unknown in 10 patients). The estimated 3-year rebleeding-free rate was 74.8%, and multivariate analysis showed that CP class C was associated with rebleeding (odds ratio, 2.404; 95% confidence-interval, 1.013-5.704; P=0.047).

Conclusions

BRTO can be performed safely and effectively for the treatment of GV bleeding. However, aggravation of EV or bleeding from EV is not uncommon after BRTO; thus, periodic endoscopy to follow-up of EV with or without prophylactic treatment might be necessary in LC patients undergoing BRTO.     

自制半自动整骨器治疗桡骨远端骨折的疗效观察

目的研究自制半自动整骨器治疗闭合性桡骨远端骨折的疗效。方法采用自制半自动整骨器对60例闭合性桡骨远端骨折患暂进行复位治疗,分析其治疗后并发症发生情况,并对治疗效果进行评价。结果本组患者均复位成功,无缺血坏死等并发症发生。复位后随访3-12个月,X线影像显示骨折全部愈合,疗效评价为优53例（88．3％）,良5例（8．3％）,不满意2例（3．3％）,无失败病例,优良率为96．7％。结论采用自制半自动整骨器治疗闭合性桡骨远端骨折复位成功率高,术后并发症少,是一种安全可靠的治疗方法。     

Propranolol in the prevention of first upper gastrointestinal tract hemorrhage in patients with cirrhosis of the liver and esophageal varices

We conducted a prospective, randomized, multicenter, single-blind trial of propranolol as compared with placebo in the prevention of first upper gastrointestinal tract bleeding in patients with cirrhosis of the liver. A total of 230 patients (90 percent with alcoholism and 46 percent with a Child-Pugh grade C classification) with large esophageal varices without previous bleeding were randomly assigned to receive either propranolol (n = 118) or placebo (n = 112), after they had been divided into two groups according to the severity of their liver disease. The end points of the study were bleeding and death. The dose of propranolol was progressively increased to decrease the heart rate by 20 to 25 percent. The final doses were 40 mg of conventional propranolol and 160 and 320 mg of long-acting propranolol daily in 22 percent, 60 percent, and 18 percent of patients, respectively. The mean (+/- SD) follow-up time among survivors without bleeding was 436 +/- 172 days. The cumulative percentages of patients free of bleeding two years after inclusion in the study were 74 percent (95 percent confidence limits, 61 and 83) in the propranolol group and 39 percent (95 percent confidence limits, 15 and 69) in the placebo group (P less than 0.05). Cumulative two-year survival was 72 percent (95 percent confidence limits, 60 and 81) in the propranolol group and 51 percent (95 percent confidence limits, 37 and 64) in the placebo group (P less than 0.05). The advantage of propranolol over placebo was maintained when potentially confounding variables were adjusted with use of the Cox model. Side effects occurred in 17 percent of the patients who received propranolol and led to the stopping of treatment in 11 percent. We conclude that propranolol can decrease the incidence of first bleeding and death during a period of two years in patients with cirrhosis and large varices.     

低氧对食管癌病人血液流变学指标的影响

目的：本文观察了低氧引起的癌症患者血液流变学参数的变化。结果表明：全血粘度、血浆粘度、红细胞压积、全血还原比粘度、血沉值低氧组略低于对照组；红细胞电泳时间、纤维蛋白元值低氧组略高于对照组，但均无明显差异；血沉方程K值低氧组明显高于对照组（P＜0．05）。这些结果提示，佩戴低氧呼吸装置所产生的短时间急性缺氧，不会对人体血液流变学产生明显影响。