食管静脉曲张结扎术对胃静脉曲张及其出血的影响

目的探讨内镜下结扎(endoscopic variceal ligation,EVL)治疗食管静脉曲张后对胃静脉曲张(gastricvarices,GV)及其出血的影响。方法对2008年7月至2010年7月本科收治82例肝硬化食管静脉曲张患者行内镜下结扎根除治疗,根据治疗前是否合并胃静脉曲张分为2组,A组合并胃静脉曲张,B组无胃静脉曲张。所有患者随访至少1年以上,观察内镜下食管静脉曲张根除后胃静脉曲张的变化情况。结果 A组合并胃静脉曲张60例,B组无胃静脉曲张22例。A组45例原发性胃食管静脉曲张1型(type 1 gastroesophageal varices,GOV1型)患者胃静脉曲张消失有22例(48.9%),未发生胃静脉曲张出血,15例原发性胃食管静脉曲张2型(GOV2型)患者胃静脉曲张消失有2例(13.3%),发生胃静脉曲张出血2例(13.3%);B组22例中未发生胃静脉曲张18例(81.8%),继发胃静脉曲张4例(18.2%),无继发性胃静脉曲张出血。结论内镜下EVL术根除食管静脉曲张后对不同胃静脉曲张类型的影响不同,近一半GOV1型胃静脉曲张会发生消失,GOV2型胃静脉曲张不会消失,未消失的胃静脉曲张会增加出血风险,而80%左右患者不会发生胃静脉曲张。

Effect of endoscopic variceal ligation on gastric varicosity and its bleeding

Objective To study the effect of endoscopic variceal ligation(EVL) on gastric varicosity(GV)and its bleeding following the treatment of esophageal varicosity(EV).Methods Eighty-two cirrhotic patients with EV,admitted to our department from July 2008 to July 2010 for EVL,were divided into group A(n=60) and group B(n=22) according to whether they had GV before treatment.All patients were followed up for at least 1 year,during which changes in GV were observed by endoscopy after eradication of EV.Results GV was found in group A and no GV was observed in group B.GV disappeared in 22(48.9%) out of the 45 patients with type 1 primary gastroesophageal varicosity and in 2(13.3%) out of the 15 patients with type 2 primary gastroesophageal varicosity while GV bleeding occurred in 2(13.3%) out of the 15 patients with type 2 primary gastroesophageal varicosity in group A.No GV occurred in 18(81.8%) out of the 22 patients and secondary GV occurred in 4(18.2%) out of the 22 patients and no secondary GV bleeding occurred in group B.Conclusion The effect of EVL is different on different types of GV following the treatment of EV.GV will disappear in about 50% of patients with type 1 primary gastroesophageal varicosity and not disappear in patients with type 2 primary gastroesophageal varicosity after eradication of EV.The existing GV will increase the risk of bleeding.However,GV will not occur in about 80% of the patients after eradication of EV.