超声下胃左静脉指标在肝硬化食管静脉曲张破裂出血预测中的应用
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摘要
目的评价超声下胃左静脉指标测量在肝硬化食管胃底静脉破裂出血预测中的应用价值。方法对80例肝硬化门静脉高压患者(出血组34例,未出血组46例)和35例健康志愿者(对照组)行彩色多普勒超声检查,观察胃左静脉以及食管胃底静脉曲张情况,计算胃左静脉最大内径及胃左静脉分流指数。结果与对照组比较,门脉高压患者胃左静脉最大内径增宽,其中出血组胃左静脉最大内径大于未出血组及对照组(P<0.01)。以胃左静脉最大内径6.5 mm为出血预测标准,预测出血的特异性、敏感性和准确性分别为78.3%、73.5%、76.3%。胃左静脉分流指数截断值定于0.13时,预测出血的特异性、敏感性和准确性分别为82.5%、76.3%、69.8%。结论超声检查测量胃左静脉最大内径及胃左静脉分流指数有助于预测肝硬化食管胃底静脉破裂出血。
Objective To evaluate the predictive value of the measuring index of left gastric venous in patients with liver cirrhosis and esophageal variceal bleeding. Methods The change of left gastric vein and esophageal varices in 80 patients with liver cirrhosis and portal and 35 normal controls were observed by color Doppler sonography,and statistical analysis the max inner diameter,shunt index of left gastric vein. Results Compared with the control group,the diameter of left gastric vein widened obviously in portal hypertension group,hemorrhage group was significantly higher than that in non bleeding group and the control group( P < 0. 01). shunt index of left gastric vein in hemorrhage group was significantly higher than that in non bleeding group and the control group. Non bleeding group was significantly higher than the control group. The maximum diameter of the left gastric vein for 6. 5mm as bleeding prediction standard,predicting bleeding specificity,sensitivity and accuracy were 78. 3%,73. 5%,76. 3%. The left gastric vein shunt index is scheduled for 0. 13,predict bleeding specificity,sensitivity and accuracy were 82. 5%,76. 3%,69. 8%. Conclusion the max inner diameter and shunt index of left gastric vein are helpful for predicting gastroesophageal varices and variceal hemorrhage in Cirrhosis patients.
Objective To evaluate the predictive value of the measuring index of left gastric venous in patients with liver cirrhosis and esophageal variceal bleeding. Methods The change of left gastric vein and esophageal varices in 80 patients with liver cirrhosis and portal and 35 normal controls were observed by color Doppler sonography,and statistical analysis the max inner diameter,shunt index of left gastric vein. Results Compared with the control group,the diameter of left gastric vein widened obviously in portal hypertension group,hemorrhage group was significantly higher than that in non bleeding group and the control group( P < 0. 01). shunt index of left gastric vein in hemorrhage group was significantly higher than that in non bleeding group and the control group. Non bleeding group was significantly higher than the control group. The maximum diameter of the left gastric vein for 6. 5mm as bleeding prediction standard,predicting bleeding specificity,sensitivity and accuracy were 78. 3%,73. 5%,76. 3%. The left gastric vein shunt index is scheduled for 0. 13,predict bleeding specificity,sensitivity and accuracy were 82. 5%,76. 3%,69. 8%. Conclusion the max inner diameter and shunt index of left gastric vein are helpful for predicting gastroesophageal varices and variceal hemorrhage in Cirrhosis patients.
引文
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[11]Chen TW,Yang ZG,Wang QL,et al.Evaluation of gastric fundic and oesophageal varices by 64-row multidetector computed tomography before and after transjugular intrahepatic portosystemic shunt with concurrent left gastric vein embolization[J].Eur J Gastroenterol Hepatol,2010,22(3):289-295.
[2]汤照峰,潘楚芝,方和平,等.纳米磁流体靶向栓塞食道曲张静脉破裂出血的研究[J].中华实验外科杂志,2011,28(8):1337-1338.
[3]Hamdy HS,Hamed WA,Morcus SW,et al.Three-dimensional Doppler ultrasonographic evaluation of hemodynamic changes in the left gastric vein and hepatic artery resistive index before and after variceal band ligation[J].Egy Liver J,2012,2(3):88-95.
[4]秦将均,涂蓉,巫北海,等.胃左静脉的多层螺旋CT评价对预测食管静脉曲张出血风险的价值[J].实用放射学杂志,2011,27(9):321-322.
[5]Fang GD,Dionysiou DD,Wang Y,et al.Sulfate radical-based degradation of polychlorinated biphenyls:effects of chloride ion and reaction kinetics[J].J Hazard Mater,2012,227-228:394-401.
[7]李丹,张谊,朱张茜.胃左静脉血流参数与食管静脉曲张破裂出血的相关性研究[J].中华普通外科杂志,2012,27(3):242-243.
[8]Hino S,Kakutani H,lkeda K,et al.Hemodynamic assessment of the left gastric vein in patients with enophageal varices with color Doppler EUS:factors affecting development of esophageal varices[J].Gastrointest Endosc,2002,55(4):512-514.
[9]Kakutani H,Hino S,Koyama S,et al.How do we select an endoscopic treatment for esophageal varices on the basis of hemodynamic analysis using color Doppler endoscopic ultrasonography[J].Surg Laparosc Endosc Percutan Tech,2012,22(5):410-414.
[10]宋兵,李彩英,刘增品,等.胃左静脉MSCTA预测肝硬化门静脉高压食管胃底静脉曲张破裂岀血的价值[J].临床放射学杂志,2011,30(7):979-982.
[11]Chen TW,Yang ZG,Wang QL,et al.Evaluation of gastric fundic and oesophageal varices by 64-row multidetector computed tomography before and after transjugular intrahepatic portosystemic shunt with concurrent left gastric vein embolization[J].Eur J Gastroenterol Hepatol,2010,22(3):289-295.