口服回声型胃超声显影剂经腹超声检查法诊断胃底贲门静脉曲张  

Diagnosis of gastric fundus and cardia varices by transabdominal ultrasound with an oral cellulose-based contrast agent

作　　者：樊蓉[1] 刘治军[1] 张晶[1] 张妍[1] 张潇月 张博茗 王凯明[1] FAN Rong;LIU Zhi-jun;ZHANG Jing;ZHANG Yan;ZHANG Xiao-yue;ZHANG Bo-ming;WANG Kai-ming(Ultrasound Department,China Medical University Shengjing Hospital,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院超声科,辽宁沈阳110004

出　　处：《中国临床医学影像杂志》2021年第11期807-811,816,共6页Journal of China Clinic Medical Imaging

基　　金：国家自然科学基金(81801712)。

摘　　要：目的:探讨经腹彩色多普勒超声在口服回声型胃超声显影剂条件下对胃底贲门静脉曲张的诊断价值。方法:根据不同的经腹彩色多普勒超声(TUS)检查方式将患者分为3组:空腹组(ES组);饮水组(OW组);口服回声型胃超声显影剂组(OCCA组)。TUS对胃底贲门静脉曲张分级:UX级:图像欠佳;U0级:未见曲张静脉;U1级:管径<5 mm且速度<10 cm/s;U2级:管径<5 mm且速度≥10 cm/s;U3级:管径5~<10 mm且速度<10 cm/s;U4级:管径5~<10 mm且速度≥10 cm/s;U5级:管径≥10 mm,任意速度。分级结果与金标准胃镜检查对比。结果:2016年8月—2020年7月前瞻性纳入肝硬化患者273例,包括出血组(n=82)和非出血组(n=191)。静脉曲张检出率OCCA组90%(126/140)>OW组57.7%(60/104)>ES组10.6%(29/273),差异有统计学意义(P<0.05)。根据TUS静脉曲张分级标准,将患者分为:UX,n=38;U0,n=20;U1,n=52;U2,n=49;U3,n=25;U4,n=51;U5,n=38;三组TUS整体与金标准胃镜检查对比,对曲张静脉管径分级符合率达92.6%(199/215),两种方法分级一致性较好(Kappa=0.85,P<0.001)。结论:TUS-OCCA极大的提高了胃底贲门静脉曲张的检出率,有较高的定量分级准确性,为胃底贲门静脉曲张检测及随访提供了便捷无创的新方法。Objective:To investigate the value of transabdominal color Doppler ultrasound with an oral cellulose-based contrast agent in the diagnosis of gastric fundus and cardia varices.Methods:Patients were divided into three groups according to using different examination methods of transabdominal color Doppler ultrasound(TUS):empty stomach group(ES group),oral water group(OW group).Oral cellulose-based contrast agent group(OCCA group).TUS-based grading of gastric fundus and cardia varices:UX:difficult to observe.U0:unobserved varices.U1:diameter<5 mm,peak velocity<10 cm/s.U2:diameter<5 mm,peak velocity≥10 cm/s.U3:diameter 5~<10 mm,peak velocity<10 cm/s.U4:diameter 5~<10 mm,peak velocity≥10 cm/s.U5:diameter≥10 mm.The grading results were compared with gastroscopy as the gold standard.Results:From August 2016 to July 2020,273 patients with cirrhosis were prospectively taken into the study,including the bleeding group(n=82)and the non-bleeding group(n=191).The detection rate of varices in OCCA group 90%(126/140)>OW group 57.7%(60/104)>ES group10.6%(29/273),the difference was statistically significant(P<0.05).According to the TUS varices grading criteria,the patients were divided into six groups:UX:n=38;U0:n=20;U1:n=52;U2:n=49;U3:n=25;U4:n=51;and U5:n=38.Compared transabdominal ultrasound examinations with the gold standard gastroscopy in the three groups,the coincidence rate of varices classification reached 92.6%(199/215),the grading consistency of the two methods was good(Kappa=0.85,P<0.001).Conclusion:TUS-OCCA greatly improves the detection rate of gastric fundus and cardia varices,which has a high accuracy of quantitative grading,and provides a convenient and non-invasive new method for the detection and follow-up of gastric fundus and cardia varices.

关 键 词：食管和胃静脉曲张 肝硬化 超声检查 多普勒 彩色 

分 类 号：R573.7[医药卫生—消化系统] K575.2[医药卫生—内科学]