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目的探讨门静脉高压症胃静脉曲张(GV)的血流动力学变化。方法经胃镜确诊为GV的22例肝硬化门静脉高压症患者,其中8例为肝癌合并门静脉主干癌栓。根据GV在胃内的位置及其与食管静脉曲张(EV)的关系,内镜将GV分为食管胃静脉曲张(GEV)和孤立的胃静脉曲张(IGV)。GEV又分2个亚型:GEV1型为EV跨过食管胃交界处,沿胃小弯侧向下延伸;GEV2型为EV跨过食管胃交界处,向胃底部延伸。22例患者均采取了经皮肝穿或脾穿门静脉造影,根据门静脉造影表现,比较不同类型GV的血液供应、引流路径及门静脉压力变化。结果GEV1、GEV2和IGV的发生率分别为54.6%(12例),31.8%(7例)和13.6%(3例)。GEV1型12例中,12例均见胃左静脉供血,胃后静脉参与供血8例(66.7%),胃短静脉参与供血3例(25%),引流路径均经奇静脉系统引流到上腔静脉。GEV2型7例,7例均见有胃左静脉、胃后静脉供血,胃短静脉参与供血4例(57.1%);7例中,5例(71.4%)经胃肾静脉分流道引流到下腔静脉,2例(29.6%)单独经奇静脉系统引流。IGV型3例,均为胃底静脉曲张(IGV1),均见胃左静脉、胃后静脉和胃短静脉供血,引流路径均经胃肾静脉分流道引流。有胃肾分流者门静脉压力为(27.0±4.2)cm水柱,无胃肾分流者门静脉压力为(37.5±5.1)cm水柱(P<0.001)。结论GV的血液供应及引流路径与GV的发生部位有关,胃肾静脉分流是胃底静脉曲张(GEV2、IGV1)的主要引流路径。
Objective To investigate the hemodynamic changes of gastric varices (GV) in patients with portal hypertension. Methods Twenty-two patients with portal hypertension were diagnosed as GV by gastroscope. Eight of them were liver cancer with portal vein tumor thrombus. GV was divided into esophagogastric varices (GEV) and isolated gastric varices (IGV) according to the location of GV in the stomach and its relationship with esophageal varices (EV). GEV is divided into two subtypes: GEV1 type EV across the esophagogastric junction, extending along the lesser curvature side of the stomach; GEV2 EV cross the esophagogastric junction, extending to the bottom of the stomach. Twenty-two patients underwent percutaneous transhepatic or splenectomy with portal vein angiography. The blood supply, drainage pathways and portal venous pressure of different types of GV were compared according to portal venography. Results The incidences of GEV1, GEV2 and IGV were 54.6% (12 cases), 31.8% (7 cases) and 13.6% (3 cases), respectively. Among the 12 cases of GEV1, gastric venous blood was supplied in 12 cases, 8 cases (66.7%) were involved in the supply of blood in the stomach and 3 cases (25%) were involved in the supply of gastric short veins. vein. In 7 cases of GEV2 type, 4 cases (57.1%) had gastric left venous blood and gastric venous blood supply, and 4 cases (57.1%) had gastric venous feeding. In 7 cases, 5 cases (71.4%) were diverted to gastric Vena cava, two cases (29.6%) were singly azygous drainage system. IGV type 3 cases were all gastric varices (IGV1), are seen in the left gastric vein, gastric vein and gastric short venous blood supply, drainage pathways are diverted by the shunt of gastric and renal veins. The portal vein pressure of gastric bypass was (27.0 ± 4.2) cm water column, portal vein pressure was (37.5 ± 5.1) cm water column (P <0.001) without gastric bypass. Conclusion GV blood supply and drainage pathways are related to the site of GV. Gastric-renal vein shunt is the main drainage path of gastric varices (GEV2, IGV1).