彩色多普勒预测食管静脉曲张程度与出血风险的价值

目的通过彩色多普勒测定胃左静脉与门静脉直径、血流速度、血流量、血流方向等血流动力学指标,探讨其预测食管静脉曲张程度与出血风险的价值。方法肝硬化门静脉高压症86例,均接受彩色多普勒、电子胃镜及肝炎标志物、肝功能等常规检验/检查。以研究对象在24个月随访期内有出血史且经内镜检查确定为食道胃底静脉曲张破裂出血为出血风险的评价标准。对比分析出血组与非出血组的胃左静脉、门静脉血流动力学特点。结果随食管静脉曲张程度的加重,胃左静脉内径呈逐渐增宽的趋势,其中食管静脉中度曲张组与无曲张组、食管静脉重度曲张组与轻度曲张组比较有显著性差异（P〈0.05）;门静脉内径随食管静脉曲张程度的加重渐增宽,其中食管静脉中度曲张组与无曲张组、食管静脉重度曲张组与轻度曲张组、食管静脉中度曲张组与轻度曲张组比较有显著性差异（P〈0.05）。胃左静脉的离肝血流方向在出血组与非出血组间均存在显著性差异（χ^2=12.049,P=0.00）,这种显著性差异在Child分级的三级肝功能状态下均存在。不同肝功能状态下门静脉的离肝血流方向在出血组与非出血组间无显著性差异（P〉0.05）。以胃左静脉内径6mm、门静脉内径16mm为预测食管静脉曲张出血风险分层指标,出血患者中门静脉内径≥16mm与非出血组比较存在显著性差异（χ^2=4.21,P=0.04）。结论彩色多普勒测定胃左静脉血流方向、门静脉内径预测食管静脉曲张出血风险具有应用价值,在预测食管静脉曲张程度上胃左静脉、门静脉血流动力学参数均无显著价值。

Value of colored Doppler forecast the esophagus varicosity degree and the hemorrhage risk

Objective To dtermines left gastric vein（LGV） and portal vein （PV）blood flow dynamics vein diameter、blood flow speed,blood flow quantity,blood flow direction） through colored Doppler,discusses its evaluation of LGV and PV blood flow dynamics predicting esophageal variceal bleeding in patient with liver cirrhosis complicated portal hypertension.Methods 86 liver cirrhosis complicated portal hypertension patients accept examinations including colored Doppler、 endoscope、hepatia and so on. Contrast analysis hemorrhage group and non-hemorrhage group＇s LGV and PV blood flow dynamics characteristic. Results Along with esophagus varicosity degree aggravating,the LGV and PV inside diameter assumes by gradually increases the width the tendency; The LGV has remarkable difference to the liver blood stream direction in the hemorrhage group with the non-hemorrhage group （χ^2=12.049,P=0.00）,this kind of remarkable difference exists in under the Child graduation three levels of liver function condition. Take LGV inside diameter 6 mm,PV inside diameter 16 mm as forecast the esophagus varicosity hemorrhage risk lamination target,bleeds in the patient PV inside diameter ≥ 16 mm to compare the existence remarkable difference with the non-hemorrhage group （χ^2=4.21,P=0.04）. Conclusion Colored Doppler determines LGV blood stream direction,PV the inside diameter forecast the esophagus varicosity hemorrhage risk has the application value,in forecast esophagus varicosity degree LGV,PV blood stream dynamics parameter not remarkable value.