肝炎肝硬化门静脉高压症胃粘膜的内镜特征  

Endoscopic features of gastric mucosa in patients with posthepatitic cirrhosis and portal hypertension.

作　　者：许瑞云[1] 潘卫东[1] 刘波[1] 汪壮流[1] 陈幼明[2] 陈小良[3] 

机构地区：[1]中山大学附属第三医院普外科,广州510630 [2]中山大学附属第三医院肝病科,广州510630 [3]中山大学附属第三医院消化内科,广州510630

出　　处：《中国实用外科杂志》2002年第8期475-477,T001,共4页Chinese Journal of Practical Surgery

基　　金：广东省科技计划项目基金 (编号 :2 0 0 12 176);广东省医药卫生科研基金资助 (编号 :A2 0 0 1195 )

摘　　要：目的　对肝炎肝硬化门静脉高压症病人胃粘膜的内镜表现进行分析研究 ,探讨以肝炎为病因的门静脉高压性胃病 (PHG)的内镜特征。方法　对 172例肝炎肝硬化门静脉高压症病人 (A组 )施行胃镜检查 ,详细记录镜下胃粘膜的病理表现及其分布 ,并与同期 114例尚未形成门静脉高压的肝炎肝硬化 (B组 )和 97例慢性胃炎 (C组 )进行对比。结果　A组主要的内镜表现包括马赛克征、糜烂、瘀点和樱桃红斑 ,检出率分别为 6 5 1%、5 0 0 %、4 5 3%和 19 8% ,均明显高于B、C两组 (P <0 0 1)。其中最基本的病变是马赛克征。樱桃红斑的检出率虽较低 ,但只在A组中见到。活动性出血的检出率A组亦高于B、C两组 (P <0 0 1)。B组与C组胃镜下的各种表现及其分布无显著性差异 (P >0 0 5 )。结论　马赛克征、糜烂和瘀点是肝炎肝硬化PHG的主要内镜表现 ,而樱桃红斑则是其特有的病变。肝炎肝硬化在形成门静脉高压以前 ,其胃粘膜的内镜表现与普通慢性胃炎相似。Objective To study the endoscopic manifestation of gastric mucosa in patients with posthepatitic cirrhosis and portal hypertension and try to find out the endoscopic features of portal hypertensive gastropathy (PHG) associated with hepatitis. Methods Gastroscopy was performed in 172 patients with posthepatitic cirrhosis and portal hypertension (group A).The gastroscopic manifestation of the gastric mucosa was recorded in detail and was compared with those of 114 patients with posthepatitic cirrhosis but without portal hypertension (group B) and 97 patients with chronic gastritis (group C).Results The principal endoscopic manifestation of gastric mucosa in group A was mosaic sign,erosion,petechia and cherry red spot.The incidence rates of these lesions were 65 1%,50 0%,45 3% and 19 8% respectively,which were higher than those in group B and group C (P<0 01).Among the lesions,mosaic sign was the basic and cherry red spot was found out only in group A.The incidence of active bleeding in group A was also higher than that in group B and group C (P<0 01).There is no difference in gastroscopic findings between group B and group C(P>0 05).Conclusion Mosaic sign,erosion and petechia were principal lesions and cherry red spot was special in patients with posthepatitic cirrhosis and portal hypertension.There is no difference in gastroscopic manifestation of gastric mucosa between patients with posthepatitic cirrhosis before progressing to portal hypertension and those with chronic gastritis.

关 键 词：内镜特征 肝炎 肝硬化 门静脉高压 胃粘膜 PHG 门静脉高压性胃病 

分 类 号：R573[医药卫生—消化系统] R575.21[医药卫生—内科学]