门静脉高压患者胃静脉曲张的内镜识别和分类

背景：肝硬化门静脉高压的出血原因中，食管和（或）胃静脉曲张破裂出血最为常见。胃静脉曲张的发生率较食管静脉曲张低，但再出血率高，出血量大，死亡率亦较高。尽管如此，胃静脉曲张在临床诊治过程中未受到应有的重视。目的：根据内镜下对食管和胃静脉曲张的识别和分类，了解食管和胃静脉曲张的比例。方法：根据Sarin分类，在内镜直视下将114例门静脉高压患者分为单纯食管静脉曲张、胃食管静脉曲张1型（GOV1型）、胃食管静脉曲张2型（GOV2型）、孤立性胃静脉曲张1型（IGV1型）和孤立性胃静脉曲张2型（IGV2型）五种类型。结果：本组患者中单纯食管静脉曲张42例（36．8％），GOV1型40例（35．1％），GOV2型20例（17．5％），IGV1型12例（10．5％），未见IGV2型。结论：半数门静脉高压患者存在胃静脉曲张，临床工作中仅处理食管静脉曲张是很片面的。须努力开展组织黏合剂、球囊闭塞下逆行经静脉栓塞术（B．RTO）或外科分流等治疗：对有条件的患者应鼓励开展肝移植治疗。

Endoscopic Features and Classification of Gastric Varices in Patients with Portal Hypertension

Background: Esophageal and/or gastric variceal bleeding is the most common cause of gastrointestinal bleeding in cirrhotic patients with portal hypertension. Although the occurrence of gastric varices is lower than that of esophageal varices, it is associated with a higher incidence of rebleeding and mortality rate. Nevertheless, insufficient emphasis has been laid on the diagnosis and treatment of gastric varices in clinical practice. Aims: To investigate the recognition and classification of esophagogastric varices for understanding the ratio of esophageal and gastric varices by means of endoscopy. Methods: The esophagogastric varices of 114 patients were classified into the following types by Sarin classification: simple esophageal varices; esophagocardiac varices (GOV1); esophagofundal varices (GOV2); isolated gastric varices confined in the fundus (IGV1); ectopic gastric varices elsewhere than fundus (IGV2). Results: Of these 114 patients, simple esophageal varices were documented in 42 patients (36.8%), GOV1 in 40 patients (35.1%), GOV2 in 20 patients (17.5%), IGV1 in 12 patients (10.5%) and no IGV2 being observed. Conclusions: Gastric varices are observed in half of the patients with portal hypertension, indicating that prejudiced treatment of esophageal varices should be avoided in clinical practice. Efforts should be made to promote the clinical application of tissue adhesive injection therapy, ballon-occluded retrograde transvenous obliteration (B-RTO), surgical shunting and especially, liver transplantation in candidates of portal hypertension.