孤立性胃静脉曲张的内镜下形态分型及临床特点  

The morphologic classification and clinical features of isolated gastroduodenal varices

作　　者：朱燕华[1] 吴云林[1] 吴巍[1] 范嵘[1] 孙萍胡[1] 李晨[1] 胡月亮[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院消化内科,上海200025

出　　处：《胃肠病学和肝病学杂志》2011年第7期637-640,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨门脉高压孤立性胃静脉曲张内镜下形态特点、分类以及与原发病种类、首发症状和胃-肾分流的关系。方法回顾分析91例孤立性胃静脉曲张患者胃镜检查图像,根据内镜下形态分为结节隆起型、条索型、葡萄串型、树枝型及混合型,并分析其临床病史资料、相关实验室检查和门脉CTA影像。结果 91例患者中结节隆起型57例(62.6%),葡萄串型14例(15.4%),条索型13例(14.3%),树枝型4例(4.4%),混合型3例(3.3%);首发症状以上消化道出血为主64例(70.3%);原发病为肝源性68例(74.7%),胰源性16例(17.6%),其他7例(7.7%);41例行门脉CTA检查的患者中,24例显示胃-肾血管分流(58.5%),17例无分流。内镜下形态分类与原发病有相关性(P<0.0001),与首发症状及是否存在胃-肾分流无关。结论内镜下形态分型可为临床的病因诊断提供线索,且有助于治疗方法的选择。Objective To categorize the isolated gastroduodenal varices by morphology and analyze the potential relevance between morphologic classification and clinical features such as initial diseases,symptoms and the gastrorenal shunt.Methods A retrospective analysis was performed in 91 portal hypertension patients with isolated gatroduodenal varices,which were classified into five types according to the endoscopic results,including tuber,trabs,grape cluster,branch and mixed type.The medical history,related laboratory examination data and imaging examination results were reviewed.Results In the 91 patients,there were tuber in 57 patients（62.6%）,grape cluster in 14 patients（15.4%）,trabs in 13 patients（14.3%）,branch in 4 patients（4.4%）and mixed type in 3 patients（3.3%）.Upper gastrointestinal hemorrhage was the main symptom in patients（64/91,70.3%）.The primary diseases included hepatic diseases（74.7%）,pancreatic diseases（17.6%）and others diseases（7.7%）.In the 41 patients who had gone through the CT portal angiography（CTPA）,24 patients showed gastrorenal shunt（58.5%）while 17 other patients didn＇t.The morphologic classification was related to primary diseases（P0.0001）.There was no evidence to the relevance between morphologic classification and first symptom or the occurrence of gastrorenal shunt.Conclusion The morphologic classification under endoscope may help the clinical diagnosis and the choosing of therapy.

关 键 词：孤立性胃静脉曲张 门静脉高压 分类 病因 内镜治疗 

分 类 号：R573.2[医药卫生—消化系统] R543.6[医药卫生—内科学]