微探头超声对腔内外联合断流前后食管下段静脉变化的研究

【作者】 刘力；

【导师】 李瑞珍；

【作者基本信息】 中南大学 ， 影像医学与核医学， 2003， 硕士

【摘要】 目的 运用微探头超声观察门脉高压症食管静脉曲张患者食管下段壁内外静脉结构治疗前后的变化，对各种治疗方法的疗效、预后进行评价。 方法 将92例患者根据治疗方法的不同随机分为三组：内镜套扎组(54例)、断流手术组(15例)、联合断流组(23例)。运用微探头超声检查治疗前后食管下段静脉结构的情况，彩色多普勒超声检测奇静脉血流动力学方面的改变，进行前后对比研究。随访追踪食管静脉曲张的复发率、再出血率。 结果 治疗后套扎组粘膜下曲张静脉消失，食管周围静脉丛仍然存在；手术组粘膜下曲张静脉存在，程度较前减轻，食管周围静脉丛消失；联合断流组食管粘膜下和周围静脉均消失。后两组治疗后穿静脉的显示率也显著降低。三组奇静脉内径较治疗前有所变小，血流速度无明显改变，血流量较前分别下降31％、32％和43％。短期追踪随访三组静脉曲张的再发率和出血率分别为24.4％、100％、5.0％和11.1％、23.1％、0％。 结论 腔内外联合断流能有效的闭塞食管下段壁内外的静脉，阻断门奇分流，防治食管静脉曲张出血与复发，而且操作简便，值得推广应用。运用微探头超声检查食管下段静脉与奇静脉血流动力学的变化在食管静脉曲张治疗的评价中具有重要意义。更多还原

【Abstract】 Objective To assess the efficacy and prognosis of different procedures by in patients with portal hypertension by miniature ultrasonic probe.Methods Ninety-two patients with esophageal varices were randomized to receive either endoscopic variceal ligation(EVL)(54/92) alone, Hassab’s procedure alone or a combination of EVL (15/92) and Hassab’s procedure (23/92) for variceal eradication. The esophagus vascular structures were examined with endoscopy and miniature ultrasonic probe and azygos blood flow (AzBF) measured with color doppler ultrasonography at right supraclavicular fossae. The change of vascular structure were evaluated. The recurrence and rebleeding of esophageal varices were investigated.Results After treatment, the esophageal varices were obliterated and collateral veins remained unchanged in patients by EVL, the esophageal varices were diminished in size and collateral veins were obliterated by Hassab’s procedure, both the esophageal varices and collateral veins were obliterated by combination of EVL and Hassab’s procedure. The frequency of forming perforating veins were observed significantly decreased in patients by Hassab’s procedure alone and combination of EVL and Hassab’s procedure. EVL, Hassab’s procedureand combination each decreased AzBF by 31% (from 0.99 ± 0.10 to 0.69 ±0.05 L/min), 32%(from 0.97±0.07 to 0.66±0.07 L/min) and 43% (from 1.00 ±0.14 to 0.57 ±0.05 L/min). During short-term follow-up, the recurrence and rebleeding rate of esophageal varices were 24.4%, 100%, 5.0% and 11.1%, 23.1 %, 0% in each group.Conclusion The combination of EVL and Hassab’s procedure can effectively shut off the portoazygous shunt, prevent esophageal varices bleeding. It’s a simply and less cost procedure. The miniature ultrasonic probe and azygos hemodynamic study play a more important role in evaluation the treatments of esophageal varices.更多还原