LDRf分型方法在消化道异位静脉曲张中的应用  

LDRf classification for ectopic varices in gastrointestinal tract

作　　者：李志群[1] 令狐恩强[2] 

机构地区：[1]解放军第261医院消化科,北京100094 [2]解放军总医院消化科

出　　处：《中华消化内镜杂志》2013年第2期64-66,共3页Chinese Journal of Digestive Endoscopy

基　　金：中国博士后科学基金（2012T50868）

摘　　要：目的探讨LD褂分型方法是否能覆盖食管胃静脉曲张以外的消化道异位静脉曲张（EcV）的内镜下分型。方法参考相关文献，采用LDRf分型方法对消化道EcV患者914例进行内镜下分型，统计病变位置（L）、血管直径（D）、危险因素（Rf）。检查门静脉高压（PH）病因，予相应治疗并随访。结果EcV按部位进行内镜下LDRf分型，包括：十二指肠198例、空肠回肠93例、胆管105例、结肠65例、直肠453例。各部位EcV血管直径为0．3～3．5cm，危险因素表现亦有不同。PH病因：肝硬化伴门静脉高压者630例（68．9％），其中自身免疫性肝病肝硬化及门静脉海绵样变性各3例（0．6％），伴食管胃静脉曲张252例（27．6％），脾切除者4例（0．5％）。EcV患者治疗315例，其中组织胶治疗43例、硬化剂治疗76例、套扎治疗74例、介入治疗52例、外科剖腹探查术70例。共19例因EcV出血死亡。内镜检查随访13～36个月，无静脉曲张复发，1年生存率100％。结论LDRf分型方法适合于全消化道静脉曲张，其对治疗方法与时机的选择具有明显指导作用，且简便、规范、统一，适合临床推广。Objective To study the feasibility of LDRf classification for gastrointestinal tract ec- topic varices （EcV） outside the esophagus. Methods Data of 914 patients with gastrointestinal EcV were classified by LDRf and analyzed for EeV location （ L）, vascular diameter （D） , and risk factor （Rf）. The etiology of the portal hypertension （PH） was determined, and the patients were treated and followed up. Results The EeVs were located in duodenum of 198 cases, in jejunum and ileum of 93, in bile duct of 105, in colon of 65, and in rectum of 453. Diameters of blood vessels of EcV varied from 0. 3 to 3.5 cm. PH causes were cirrhosis with portal hypertention in 630 patients （68. 9% ）, in which 3 were autoimmune cirrhosis and 3 were portal spongiform fiver disease （0. 6% ）. Combined esophageal and gastric varices were found in 252 cases （27.6 % ） , including 4 cases （0. 5% ） of splenectomy. Various treatments were applied in 315 patients, including endoscopic tissue adhesive injection in 43, endoscopic sclerotherapy in 76, endo- scopic ligation in 74, interventional treatment in 52, and surgical laparotomy in 70. A total of 19 patients died of variceal bleeding. The patients were followed up for 13 to 36 months, no varices relapsed, and 1-year survival rate was 100%. Conclusion LDRf classification, simple, applicable, standardized, is suitable for the whole gastrointestinal varicose veins.

关 键 词：静脉曲张 异位 内窥镜检查 高血压 门静脉 LDRf分型 

分 类 号：R575.2[医药卫生—消化系统]