肝硬化门脉高压性胃病的相关性研究

目的探讨肝硬化门脉高压性胃病（PHG）的临床特点及其与肝功能分级、食管静脉曲张以及食管静脉曲张套扎术干预治疗的关系。方法对268例肝硬化患者进行肝功能及常规胃镜检查，并对其并发PHG及干预治疗后PHG情况进行分析。结果268例肝硬化患者有不同程度的食管静脉曲张246例（91．8％），PHG发生率为102例（38．1％），原为轻型PHG22例患者在接收套扎术治疗后6例（27．2％）转化为重型PHG。随肝功能分级积分（级别）的增加以及食管静脉曲张严重程度的增加，PHG发病率增加（P〈0．05）。结论肝硬化患者PHG发病率随肝功能分级、食管静脉曲张严重程度的增加以及多次干预食管静脉曲张治疗手段而上升。     

肝硬变并发门脉高压性胃病的研究

目的　探讨肝硬变并发门脉高压性胃病的情况。方法　对 390例门诊及住院的肝硬变患者常规进行胃镜检查 ,并对不同肝功能水平患者门脉高压性胃病发生情况进行回顾分析。结果　 390例肝硬变患者中 ,食管 胃底静脉曲张 330例 (84 .6 % ) ;门脉高压性胃病发生率 4 9.2 % (192例 )。根据Child Pugh分级将肝功能分为A、B、C 3级 ,随肝功能级别增加门脉高压性胃病发生率随之增加 ,随食管 胃底静脉曲张严重程度上升 ,门脉高压性胃病发生率亦呈上升趋势 (P <0 .0 5 )。结论　门脉高压性胃病随肝功能分级增加而上升 ,随食管 胃底静脉曲张严重程度的增加而上升 ,对肝硬变患者应常规胃镜检查。     

肝硬化并发门脉高压性胃病临床分析

目的:观察门脉高压性胃病(PHG)发病率与肝功能分级及食管静脉曲张(EV)严重程度的关系.方法:对200例肝硬化住院患者采用回顾性分析,将PHG的发病率与肝功能分级及EV严重程度进行比较.结果:200例肝硬化患者中,PHG 97例(48.5%),EV154例(77%).肝功能Child-Pugh分级与PHG发病率呈明显正相关(P<0.01),EV程度与PHG发病率亦呈明显正相关(P<0.01).结论:PHG的发病率与肝功能分级及EV严重程度之间呈正相关.     

肝硬化并上消化道出血52例临床分析

目的：探讨肝硬化合并上消化遭出血患者的出血原因，并指导治疗。方法：对52例肝硬化合并上消化遭出血患者均行急诊胃镜检查及Child-pugh分级。结果：（1）52例肝硬化合并上消化道出血的原因：静脉曲张破裂出血占51．92％，非静脉曲张破裂出血占48．08％，两者比较。无显著性差异（P〉0．05）。在Child—pughA级中。静脉曲张破裂出血占23．08％，非静脉曲张破裂出血占5．77％．两者比较，有显著性差异（P〈0．05），在Child-pughC级中，非静脉曲张破裂出血占25．00％，静脉曲张破裂出血占11．53％，两者比较。有显著性差异（P〈0．05）；（2）非静脉曲张破裂出血原因包括消化性溃疡和门脉高压性胃病，在Child-pughC级中，门脉高压性胃病出血占17．31％，消化性溃疡出血占7．69％，两者比较，有显著性差异（P〈0．05）。结论：肝硬化合并上消化道出血病因中．门脉高压性胃病及消化性溃疡也是消化道出血的重要原因，尤其在肝功能Child-pughC级的患者中更应引起重视。     

肝硬化患者胃镜下表现与肝脏疾病程度的相关性

目的:通过观察肝硬化患者胃镜下的表现,分析各种镜下表现与肝功能分级之间的关系,为判断肝硬化门脉高压的程度及预防上消化道出血提供客观依据.方法:对182例肝硬化患者常规进行胃镜检查,记录食管静脉曲张、门脉高压性胃病(PHG)、溃疡及幽门螺杆菌(Hp)感染的情况,并对以上患者进行肝功能Chid-pugh分级,探讨不同肝功能分级及门、脾静脉内径与胃镜下表现的关系.结果:随着肝功能损害程度的增加,食管静脉曲张程度及门脉高压性胃病的发生率呈上升趋势(P＜0.01);溃疡的发生率与肝功能Child-Pugh分级之间无相关性(P＞0.05);随着食管静脉曲张程度的加重,PHG的发生率及溃疡的发病率呈上升趋势(P＜O.01);却感染与PHG的发生无相关性(P＞O.05);溃疡的发生率在Hp阴性组和阳性组之间无明显差异(P＞0.05);门、脾静脉内径与食管静脉曲张和PHG程度呈正相关性(P＜0.01).结论:肝功能损害的程度与食管静脉曲张程度及门脉高压性胃病的发生率呈正相关.     

门脉高压性胃病相关因素临床分析

目的 :了解门脉高压性胃病形成的相关因素。方法 :根据胃镜下有无门脉高压性胃病对 6 2例肝硬化患者进行分组对照研究。结果 :门脉高压性胃病组与无门脉高压性胃病组比较 ,在肝功能分级、食管静脉曲张的程度、静脉曲张的硬化剂治疗以及体内血浆蛋白水平有着显著的差异 (P <0 .0 1) ,而与病程、血清胆红素、血氨水平、凝血酶原时间无相关性 (P >0 .0 5 )。门脉高压性胃病组的幽门螺杆菌的感染率较对照组低 (P <0 .0 5 )。结论 :肝功能分级、食管静脉曲张的程度、硬化剂治疗及血浆蛋白水平与门脉高压性胃病有着较为密切的关系。     

肝硬化门静脉高压性胃病患者幽门螺杆菌感染的临床研究

目的探讨肝硬化门静脉高压性胃病患者幽门螺杆菌（Helicobacterpylori,Hp）感染的临床特点。方法对2000年1月-2010年12月收治的51例确诊肝硬化并已行胃镜检查、Hp快速尿素酶试验的住院患者的Hp感染状况及相关因素进行回顾性研究。结果肝硬化门静脉高压性胃病患者Hp感染率为：4l.2％;Hp感染与年龄无关（P〉0．05）;Hp感染率随食管静脉曲张加重、肝功能恶化而降低（P〈O．05）;而与门静脉高压性胃病的发生（包括胃黏膜糜烂及溃疡）无关（P〈O．01）。结论肝硬化门静脉高压性胃病的发生与Hp感染无关。对有Hp感染的肝硬化门静脉高压性胃病患者无需常规行Hp根除治疗。     

门脉高压性胃病50例临床分析

目的：门脉高压性胃病是肝硬化并发上消化道出血的重要原因。其程度与食管静脉曲张程度之间存在一定的依从关系。重视并及时治疗。可防止门脉高压性胃病加重合并出血。方法：回顾总结1998年-2003年我院消化内科收治的门脉高压性胃病并发上消化道出血患者50例，均经胃镜检查明确出血原因。结果：50例门脉高压性胃患者中轻型门脉高压性胃病20例。重型30例。所有病例均有不同程度的食管静脉曲张，其中，轻度食管静脉曲张13例，中度20例，重度17例，重型门脉高压性胃病合并出血22例，食管胃底静脉曲张破裂出血24例。结论：50例门脉高压性胃病中，均有不同程度的食管胃底静脉曲张，食管静脉曲张重者，以曲张静脉破裂出血为主，而轻者，以门脉高压性胃病并出血为主。     

肝源性溃疡的临床分析

目的：观察肝源性溃疡的镜下特点及其与功能损害、门脉高压的关系。方法：对262例肝硬化高压患者的临床资料作了回顾性分析，其中肝源性溃疡患者按肝功能害程度及食管静脉曲张程度分组。结果：内镜下以十二指肠溃疡多见，其中浅表溃疡占70．49％，长径＜0．5cm的溃疡占55．74％，伴发糜烂性胃炎者占62．30％。262例中发现肝源性溃疡61例，发生率为23．28％。经x^2检验，表明它与肝功能分级及食管静脉曲张程度均有关（P＜0．05）。结论：肝源性溃疡的发病明显高于正常人群，其发生与肝功能损害及食管静脉曲张严重程度呈正相关。     

肝病性溃疡的临床分析

目的 观察肝病溃疡的镜下特点及其与肝功能损害、门脉高压的关系。方法 对262例肝硬化门脉高压患者的临床资料作了回顾性分析，其中肝病性溃疡患者按肝功能损害程度及食管静脉曲张度分组。结果 内镜下以十二指肠溃疡多见，其中浅表溃疡占70．49％，直径〈0．5cm的溃疡占55．74％，伴发糜烂性胃炎者占62．30％。262例中发现肝源性溃疡61例，发生率为23．28％，经x^2检查，表明它与肝功能分级及食管静脉曲张程度有关系（P〈0．05）。结论 消化性溃疡患者中肝病性溃疡的发病明显高于正常人群，其发生与肝功能损害及食管静脉曲张程度呈正相关。     

自发性脾肾分流对门静脉高压性胃病的影响

目的探讨自发性脾肾分流对门静脉高压性胃病的影响。方法对我院2000年3月～2004年9月收治的门静脉高压症病人217例分别进行内镜和彩色多普勒检查。根据有无自发性脾肾分流将病人分成A、B两组，比较两门静脉高压性胃病的发生率和严重程度。结果具有自发性脾肾分流(A组)的患者为43人，无自发性脾肾分流(B组)的患者为174人，自发性脾肾分流的发生率为19．35％。A组门静脉高压性胃病的发生率为23．26％，B组的发生率为54．59％，A、B两组门静脉高压性胃病发生率差异的比较有显著性(P=0.000)。门静脉高压性胃病的轻重与有无自发性脾肾分流具有相关性(R=0．283，P=0．000)。结论自发性脾肾分流能降低门静脉高压性胃病的发生率并缓解其严重程度，在行脾切除术时注意保护自发性的脾肾分流。     

The accuracy of PillCam ESO capsule endoscopy versus conventional upper endoscopy for the diagnosis of esophageal varices: a prospective three-center pilot study

BACKGROUND AND STUDY AIMS: Variceal bleeding is a major complication of cirrhosis, and is associated with a 20 % mortality at 6 weeks. Current international guidelines recommend that patients with cirrhosis are screened by conventional upper endoscopy (esophagogastroduodenoscopy, EGD) in order to detect esophageal varices. The recently developed PillCam ESO esophageal capsule endoscope has been shown to be an accurate diagnostic tool in the investigation of patients with gastroesophageal reflux and Barrett's esophagus. We compared the PillCam ESO capsule endoscope with EGD for the detection of esophagogastric varices and portal hypertensive gastropathy in patients with cirrhosis. PATIENTS AND METHODS: A pilot trial was conducted at three sites. Patients with cirrhosis who were undergoing clinically indicated EGD for screening or surveillance for esophageal varices underwent a PillCam ESO study followed by an EGD within 48 hours. Capsule videos were assessed by an investigator who was blinded to the patient's medical history and EGD findings. RESULTS: A total of 23 of the 32 enrolled patients were found to have esophageal varices at both EGD and PillCam ESO endoscopy. In one patient PillCam ESO detected small varices that were not seen at EGD. The overall concordance between PillCam ESO and EGD was 96.9 % for the diagnosis of esophageal varices and 90.6 % for the diagnosis of portal hypertensive gastropathy. There were no adverse events related to PillCam ESO endoscopy. CONCLUSIONS: In a high-prevalence population, PillCam ESO may represent an accurate noninvasive alternative to EGD for the detection of esophageal varices and portal hypertensive gastropathy. A large-scale trial is underway to validate and expand these findings.     

Effect of esophageal variceal band ligation on hemorrhoids, anorectal varices, and portal hypertensive colopathy

BACKGROUND AND STUDY AIMS: Although it is known that obliteration of esophageal varices following endoscopic variceal band ligation results in an increase in the incidence of portal hypertensive gastropathy, the effect of variceal ligation on hemorrhoids, anorectal/colonic varices and portal hypertensive colopathy is not known. The aim of this study was to investigate the effect of endoscopic variceal band ligation on hemorrhoids, anorectal/colonic varices and portal hypertensive colopathy. PATIENTS AND METHODS: A total of 60 consecutive patients with cirrhosis of the liver and portal hypertension were prospectively studied. Upper gastrointestinal endoscopy and full-length colonoscopy were carried out before the patients underwent endoscopic variceal band ligation for esophageal varices and after obliteration of the varices following band ligation. RESULTS: Obliteration of esophageal varices by endoscopic variceal band ligation did not affect the incidence of hemorrhoids (37 % before and after), anorectal varices (40 % before and after), and portal hypertensive colopathy (57 % before and after). CONCLUSIONS: It is concluded that esophageal variceal band ligation does not affect the incidence of hemorrhoids, anorectal varices or portal hypertensive colopathy in patients with cirrhosis of the liver.     

Pathogenesis of esophagitis in patients with portal hypertension

Acidogenic function of the stomach and role of gastroesophageal reflux were assessed in relation to esophagitis genesis in 92 patients with portal hypertension and varicosity of the stomach and esophagus. Acidogenic function was found heterogenous. The relationship between gastric acidity, gastroesophageal reflux and esophagitis development seemed obscure, whereas that between esophageal varicosity of a definite degree and esophagitis was clear-cut.     

Effect of esophageal variceal sclerotherapy on hemorrhoids, anorectal varices and portal colopathy

BACKGROUND AND STUDY AIMS: Endoscopic sclerotherapy (EST) results in an increase in the prevalence of portal hypertensive gastropathy (PHG). However, the effects of sclerotherapy on hemorrhoids, anorectal or colonic varices and portal hypertensive colopathy are not known. The aim of this study was to investigate these effects. PATIENTS AND METHODS: A total of 39 patients with portal hypertension were studied. Upper gastrointestinal endoscopy and full-length colonoscopy were carried out before the patients underwent EST for esophageal varices, and after obliteration of the varices following sclerotherapy. RESULTS: The obliteration of esophageal varices by EST did not significantly affect the prevalence of hemorrhoids (32 % before and after), anorectal varices (45% before and after) or portal hypertensive colopathy (60.5 % before and 66 % after, P > 0.05). CONCLUSION: Obliteration of esophageal varices does not affect the prevalence of hemorrhoids, anorectal varices, or portal hypertensive colopathy.     

奥曲肽治疗肝硬化门静脉高压合并食管下段胃底静脉曲张首次破裂出血近期疗效观察

目的观察奥曲肽治疗肝硬化门静脉高压合并食管下段胃底静脉曲张首次破裂出血近期疗效及其不良反应。方法将50例肝硬化门静脉高压合并食管下段胃底静脉曲张首次破裂出血病人随机分为两组,对照组30例,奥曲肽治疗组20例,对照组在基础治疗(制酸、护肝、降低门静脉压、补液等)上加垂体后叶素治疗;治疗组在基础治疗上加奥曲肽治疗。同时观察两组止血情况及不良反应。结果治疗组有效率82.4%,对照组有效率61.2%,两组比较有差异统计学意义(P<0.05),且奥曲肽组不良反应少,患者耐受性好。结论奥曲肽治疗肝硬化门静脉高压合并食管下段胃底静脉曲张首次破裂出血近期疗效好,不良反应少,值得临床推广使用。     

Role of Helicobacter pylori in cirrhotic patients with dyspepsia: a 13C-urea breath test study

The role ofHelicobacter pylori in dyspeptic, cirrhotic patients remains unclear. This prospective outpatient study, conducted to assess the relationship of gastroduodenal disease andH. pylori as determined by the (¹³C) urea breath test, enrolled 109 consecutive cirrhotic patients with dyspepsia. All patients underwent upper-gastrointestinal endoscopy, which revealed respective prevalences of peptic ulcer, gastric ulcer, and duodenal ulcer of 41.3%, 23.9%, and 22.9%;H. pylori infection was found in 52.3%. The rate of peptic ulcer disease in theH. pylori-positive (45.6%) and -negative (36.5%) groups was not significantly different; neither was the prevalence ofH. pylori in patients with or without portal hypertensive gastropathy and with or without esophageal varices. The relationship between peptic ulcer disease andH. pylori in dyspeptic patients with cirrhosis appears to be weak. Likewise, no significant relationship was evident betweenH. pylori and portal hypertensive gastropathy or esophageal varices. This organism may not be a major pathogenetic factor in gastroduodenal diseases in dyspeptic patients with cirrhosis.     

急诊与择期门奇断流治疗食管胃底静脉曲张破裂大出血

目的总结和分析肝硬化门脉高压上消化道大出血行脾切除加门奇断流术的疗效。方法对我院2000年1月至2006年12月间择期门奇断流术46例和急诊门奇断流术21例的临床资料进行回顾性分析。结果本组67例术后上消化道出血均停止。急诊手术的手术并发症发生率、术后再出血率两组间差异无统计学意义,但急诊手术对术后肝脏功能有一定影响。结论脾切除加门奇断流术治疗门静脉高压食管胃底静脉曲张破裂大出血是安全有效的治疗方法,止血效果确切、手术时机的把握和围术期处理是急诊手术成功的关键。