CHESS消化内镜测量尺客观测量肝硬化门静脉高压食管静脉曲张直径的前瞻性、多中心研究  

CHESS endoscopic ruler in objective measurement of diameter of esophageal varices in liver cirrhosis and portal hypertension:a prospective multicenter study

作　　者：呼圣娟[1] 胡建平[2] 杨少奇[3] 李小果 邓燕红 石瑞春 李晓琴 祁海龙[7] 沈迁 何芳[3] 朱军 马斌[2] 于小兵[1] 郭建阳[1] 余月华[2] 雍海江 姚文暾[3] 叶婷[3] 王桦 董文福 刘建国 魏强 田婧 何浩翔 何昌辉 黄义飞 卜阳 祁小龙 Hu Shengjuan;Hu Jianping;Yang Shaoqi;Li Xiaoguo;Deng Yanhong;Shi Ruichun;Li Xiaoqin;Qi Hailong;Shen Qian;He Fang;Zhu Jun;Ma Bin;Yu Xiaobing;Guo Jianyang;Yu Yuehua;Yong Haijiang;Yao Wentun;Ye Ting;Wang Hua;Dong Wenfu;Liu Jianguo;Wei Qiang;Tian Jing;He Haoxiang;He Changhui;Huang Yifei;Bu Yang;Qi Xiaolong(Department of Gastroenterology,People′s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;Department of Gastroenterology,the First People′s Hospital of Yinchuan,Yinchuan 750010,China;Department of Gastroenterology,General Hospital of Ningxia Medical University,Yinchuan 750003,China;Institute of Portal Hypertension,the First Hospital of Lanzhou University,Lanzhou 730030,China;Department of Gastroenterology,Wuzhong People′s Hospital,Wuzhong 751199,China;Department of Gastroenterology,the Fifth People′s Hospital of Ningxia Hui Autonomous Region,Shizuishan 753000,China;Department of Gastroenterology,Shizuishan Second People′s Hospital,Shizuishan 753000,China;Department of Gastroenterology,Yinchuan Second People′s Hospital,Yinchuan 750011,China;Department of Gastroenterology,Zhongwei People′s Hospital,Zhongwei 755000,China;Shanghai Alton Medical Devices Co.,LTD,Shanghai 201900,China;Center of Portal Hypertension,Department of Radiology,Zhongda Hospital Southeast University,Nanjing 250012,China)

机构地区：[1]宁夏回族自治区人民医院消化内科,银川750002 [2]银川市第一人民医院消化内科,银川750010 [3]宁夏医科大学总医院消化内科,银川750003 [4]兰州大学第一医院门静脉高压研究所,兰州730030 [5]吴忠市人民医院消化内科,吴忠751199 [6]宁夏回族自治区第五人民医院消化内科,石嘴山753000 [7]石嘴山市第二人民医院消化内科,石嘴山753000 [8]银川市第二人民医院消化内科,银川750011 [9]中卫市人民医院消化内科,中卫755000 [10]上海埃尔顿医疗器械有限公司,上海201900 [11]东南大学附属中大医院放射科门静脉高压中心,南京250012

出　　处：《中华消化杂志》2023年第3期193-198,共6页Chinese Journal of Digestion

摘　　要：目的:探索CHESS消化内镜测量尺(以下简称CHESS尺)操作的安全性、可行性及其测量数值与内镜医师经验性判读的一致性。方法:前瞻性纳入2021年1月至2022年1月宁夏回族自治区人民医院总院、西夏分院、宁南医院(29例),以及银川市第一人民医院(25例)、宁夏医科大学总医院(18例)、吴忠市人民医院(10例)、宁夏回族自治区第五人民医院(10例)、石嘴山市第二人民医院(6例)、银川市第二人民医院(5例)、中卫市人民医院(2例)共8家医院收治的105例肝硬化门静脉高压患者。记录所有患者的临床特征,包括性别、年龄、民族、肝硬化病因、肝功能Child-Pugh分级等。将静脉曲张直径≥5 mm定义为大静脉曲张。由内镜医师(副主任医师职称)按照胃镜检查常规流程对患者进行电子胃镜操作,并对最大食管静脉曲张直径进行经验性判读和图像采集,然后通过CHESS尺进行客观测量和图像采集。由6名内镜医师(主治医师或副主任医师职称)对随机(随机数字表法)选取的10例患者分别采用CHESS尺测量或根据经验判读静脉曲张直径。采用Kappa检验分析内镜医师经验性判读与CHESS尺客观测量判读大静脉曲张分级的一致性。结果:在105例肝硬化门静脉高压患者中,男65例,女40例;年龄为(54.8±12.2)岁;汉族82例,回族21例,蒙古族2例;肝硬化病因包括乙型病毒性肝炎79例,酒精性肝病7例,自身免疫性肝炎7例,丙型病毒性肝炎2例,其他病因10例;肝功能Child-Pugh A级32例,Child-Pugh B级57例,Child-Pugh C级16例。105例肝硬化门静脉高压患者均成功完成CHESS尺测量食管静脉曲张直径,CHESS尺应用成功率为100.0%(105/105)。从CHESS尺进入体内、测量完成到退出体外的检查时长为(3.50±2.55)min。测量过程所有患者均未发生操作相关并发症。在105肝硬化门静脉高压患者中,内镜医师经验性判读为大静脉曲张96例(91.4%),CHESS尺判读为大静脉曲张Objective To investigate the safety and feasibility of the CHESS endoscpic ruler(CHESS ruler),and the consistency between the measured values and the interpretation values by endoscopic physician experience.Methods From January 2021 to January 2022,a total of 105 liver cirrhosis patients with portal hypertension were prospectively enrolled from General Hospital,Xixia Branch Hospital,Ningnan Hospital of People′s Hospital of Ningxia Hui Autonomous Region(29 cases),and the First People′s Hospital of Yinchuan(25 cases),General Hospital of Ningxia Medical University(18 cases),Wuzhong People′s Hospital(10 cases),the Fifth People′s Hospital of Ningxia Hui Autonomous Region(10 cases),Shizuishan Second People′s Hospital(6 cases),Yinchuan Second People′s Hospital(5 cases),and Zhongwei People′s Hospital(2 cases)8 hospitals.The clinical characteristics of all the patients,including gender,age,nationality,etiolog of liver cirrhosis,and Child-Pugh classification of liver function were recorded.A big gastroesophageal varices was defined as diameter of varices≥5 mm.Endoscopist(associated chief physician)performed gastroscopy according to the routine gastroscopy procedures,and the diameter of the biggest esophageal varices was measured by experience and images were collected,and then objective measurement was with the CHESS ruler and images were collected.The diameter of esophageal varices of 10 randomly selected patients(random number table method)was determined by 6 endoscopists(attending physician or associated chief physician)with experience or measured by CHESS ruler.Kappa test was used to test the consistency in the diameter of esophageal varices between measured values by CHESS ruler and the interpretation values by endoscopic physician experience.Results Among 105 liver cirrhosis patients with portal hypertension,male 65 cases and female 40 cases,aged(54.8±12.2)years old,Han nationality 82 cases,Hui nationality 21 cases and Mongolian nationality 2 cases.The etiology of liver cirrhosis included chronic hep

关 键 词：消化内镜测量尺 肝硬化 高血压 门静脉 食管和胃静脉曲张 

分 类 号：R575.2[医药卫生—消化系统]