超声微探头对肝硬化门脉高压食管下段静脉结构的研究  

Ultrasonic Microprobe Study on Distal Esophageal Venous Structure of Portal Hypertension in Liver Cirrhosis

作　　者：李瑞珍[1] 陈琮瑛[1] 李胜利[1] 刘浔阳[2] 黄飞舟[2] 聂晚频[2] 朱晒红[2] 

机构地区：[1]湖南医科大学附属第三医院超声科 [2]湖南医科大学门脉高压研究中心

出　　处：《中国超声医学杂志》2000年第12期919-922,共4页Chinese Journal of Ultrasound in Medicine

基　　金：卫生部临床学科重点医疗项目资助(160)

摘　　要：目的 :本文试图用经内镜超声微探头 (Ultrasonic Microprobe UMP)探讨门脉高压时食管下段壁内外静脉的解剖形态变化及其之间的相互关系。方法 :我们对 2 1例经临床资料和腹部超声明确诊断有肝硬化门脉高压的患者 ,在常规内镜检查完毕后 ,用频率为 2 0 MHz,直径为 2 .2 mm的超声微探头经内镜活检孔插入至食管腔内 ,并采用水浸法于内镜直视下扫查食管下段 ,详细观察了食管粘膜下曲张静脉 ,食管旁静脉及两者之间的连接静脉—穿静脉的大小、形态、数目及曲张静脉壁厚度 ,分析各曲张静脉之间的相互关系。另外以 6例证实无门脉高压食管静脉曲张的其他患者作为对照组。结果 :超声微探头显示门脉高压时食管粘膜下曲张静脉 ,食管旁静脉均扩大曲张 ,部分可见两者之间的连接静脉 -穿静脉亦显示扩张。食管旁静脉曲张越重 ,食管粘膜下静脉曲张程度越重 ,两者之间存在显著相关性 (r=0 .6 2 6 ,P<0 .0 1)。重度食管粘膜下曲张静脉的穿静脉显示率明显高于轻中度 (重度为 87.5 % ,中度为 2 5 % ,1例轻度静脉曲张患者无穿静脉和旁静脉显示 )。食管曲张静脉直径和其壁厚度呈负相关 ,但无统计学显著性意义 (r=- 0 .40 4,P=0 .0 6 6 )。结论 :超声微探头能简便、安全、客观、精确地评价门脉高压时食管下段静脉曲张 ,揭示食管?Objective:To investigate the changes of venous anatomy inside and outside the esophageal wall and their relationship in patients with cirrhotic portal hypertension by ultrasonic microprobe (UMP) and endoscopy We try to provide theoretic evidence for clinical prevention of varices bleeding by this study Methods:Twenty one patients with untreated esophageal varices were examined by both endoscopy and UMP The collateral veins were studied with 20 MHz UMP through biopsy channel of endoscope by water immerged method Size and wall thickness and number of varices inside and outside esophageal wall were measured and analyzed Another 6 cases without esophageal varices as control were examined Results:Submucosal and paraesophageal veins were displayed as dilated rounded anechoic structures The more evident the paraesophageal veins,the more severe the submucosal varices,There was significantly positive relationship between them( r =0 626, P <0 01) The more severe the varices formed at endoscopy,the more likely were perforating veins visualized at UMP imaging The mean dimater of varices was negativly correlated with the wall thickness, but no significance was found( r =-0 404, P =0 066) Conclusions: UMP is a simple,safe,and well tolerated technique and can quantify the size of varices and wall thickness of the esophagus objectively and accurately The relationships of veins inside and outside the esophageal wall were well displayed by UMP which provides theoretical evidence for clinical preventing and therapy of varices bleeding

关 键 词：超声微探头 食管静脉曲张 门脉高压症 肝硬化 

分 类 号：R575.2[医药卫生—消化系统]