胃静脉曲张的病因及临床特点

目的探讨胃静脉曲张的病因及临床特点。方法回顾性分析北京协和医院2000年1月至2005年4月胃静脉曲张患者的病因及并发出血的情况,胃静脉曲张出血与红色征、曲张静脉类型、程度的关系,以及各型曲张静脉发生门脉高压性胃病的情况。结果我院5年间共诊治胃静脉曲张407例,占同期全部食管、胃静脉曲张的47.1%。胃静脉曲张的病因中,肝硬化占74.4%。孤立性胃静脉曲张的病因中脾静脉阻塞占37.2%,肝硬化占33%。407例胃静脉曲张患者中出血121例(29.7%)。在1型和2型胃静脉曲张、1型孤立性胃静脉曲张患者中,出血组红色征的阳性率、静脉曲张的程度均显著高于未出血组(P<0.01)。门脉高压所致的304例胃静脉曲张患者中发生门脉高压性胃病60例(19.7%),与食管静脉曲张发生门脉高压性胃病(22.3%)无差异,但孤立性胃静脉曲张很少出现门脉高压性胃病(9.6%,P<0.05)。结论胃静脉曲张最常见的病因是各种原因引起的肝硬化,而孤立性胃静脉曲张最常见的病因是脾静脉阻塞。红色征、静脉曲张程度是胃静脉曲张出血的危险因素。胃静脉曲张对门脉高压性胃病无影响。

The Etiology and Clinical Aspects of Gastric Varices

Objective To explore the etiology and clinical aspects of gastric varices.Methods The etiology and the prevalence of bleeding in patients with gastric varices from Jan. 2000 to Apr. 2005 in Peking Union Medical College Hospital were analyzed retrospectively. The relations between gastric varices and the red-color sign, forms and degrees of the varices as well as the prevalence of portal hypertensive gastropathy were evaluated. Results There were 407 patients with gastric varices in our hospital, accounting for 47.1% of all patients with gastroesophageal varices in five years. Cirrhosis was the most common cause of gastric varices (74.4%), while isolated gastric varices occurred more in splenic venous obstruction (37.2%) and cirrhosis (33%). One hundred and twenty-one patients with gastric varices bled (29.7%). The red-color sign was more prevalent and the degree of the varices was greater in patients with hemorrhagic type 1 and 2 gastroesophageal varices and type 1 isolated gastric varices (P<0.01). There were 60 portal hypertensive gastropathy in 304 patients with gastric varices (19.7%), comparable to that in patients with esophageal varices(22.3%). Portal hypertensive gastropathy was significantly low in patients with isolated gastric varices (9.6%, P< 0.05 ).Conclusion The most common cause of gastroesophageal varices is cirrhosis, while splenic venous obstruction is the most common cause of isolated gastric varices. The red-color sign and degree of the varices are risk factors for bleeding from gastric varices except for isolated gastric varices. The presence of gastric varices has no influence on portal hypertensive gastropathy.