超聲內鏡對食管胃底靜脈曲張診斷價值及與多層螺旋CT血管造影診斷比較
發(fā)布時間：2018-12-20 05:43
【摘要】：目的1.分析肝硬化及慢性乙型肝炎(chronic viral hepatitis B,CHB)患者超聲內鏡(endoscopic ultrasonography,EUS)下胃底食管靜脈曲張(esophageal and gastric varices,EGV)各部位檢出情況,評估EUS對EGV的早期診斷價值。通過EUS對于入組患者進行隨訪,了解EGV變化,評估預后。2.探討EUS與門脈CT血管造影(Computed Tomography Angiography,CTA)在肝硬化患者EGV診斷方面的一致性。方法1.采用EUS對116例胃鏡下未見EGV的乙肝后肝硬化患者及182例CHB患者進行檢測,按照曲張靜脈的部位及程度進行分級,分析兩組患者食管胃底各部位靜脈曲張及穿通支的檢出情況。2.肝硬化組按照Child-Pugh分級分成3組,CHB組按照是否抗病毒治療分為2組,1年后對所有入組患者復查EUS,分析隨訪前后EGV變化情況。3.選取84例肝硬化患者做為研究對象,總結EUS及CTA對食管胃底粘膜下及外周靜脈曲張檢出情況,比較兩者診斷方面的一致性。結果1.肝硬化組中,101例患者可檢出多于一個部位的胃食管外周靜脈曲張,68例患者可檢出兩個以上部位胃食管外周靜脈曲張,21例患者同時檢出食管黏膜下及食管外周靜脈曲張,30例患者可同時檢出胃底粘膜下及胃底外周靜脈曲張。2.肝硬化組與CHB組相比,食管及胃底黏膜下靜脈曲張、食管及胃底旁靜脈曲張、食管及胃底周圍靜脈曲張檢出情況差異均有統(tǒng)計學意義(P0.05)。兩組患者穿通支檢出情況相比,差異有統(tǒng)計學意義(P0.05)。3.1年后再次復查EUS,肝硬化患者中,68例Child A級患者各部位靜脈曲張未見明顯變化,6例患者靜脈曲張消退或減輕,1例患者由Child A級進展為Child C級。8例Child B級患者靜脈曲張程度加重,5例患者發(fā)現(xiàn)新的靜脈曲張。4例Child C級患者靜脈曲張程度加重,2例患者發(fā)現(xiàn)新的靜脈曲張。4.HBV抗病毒組,23例靜脈曲張程度減輕或消退。未抗病毒組,4例患者靜脈曲張程度加重,6例患者出現(xiàn)新發(fā)靜脈曲張,1例患者進展為肝硬化Child A級。5.EUS與門脈CTA相比,對于食管黏膜下靜脈曲張檢出不具有高度一致性(P0.05)。對于食管外周靜脈、胃底黏膜下靜脈及胃底外周靜脈,EUS與門脈CTA在靜脈曲張檢出率方面具有高度一致性(P0.05)。結論1.對于在胃鏡下未見到靜脈曲張的肝硬化及CHB群體而言,EUS可以發(fā)現(xiàn)食管胃底黏膜下靜脈曲張及外周靜脈曲張,對更早期診斷肝硬化及區(qū)分病情程度具有意義。2.抗病毒治療可以延緩肝硬化靜脈曲張的進展,通過抗病毒治療可使部分早期肝纖維化患者靜脈曲張得到一定程度逆轉。但對于Child B-C級患者,即使進行抗病毒治療,仍然不能完全阻止靜脈曲張加重。3.未抗病毒治療的CHB患者,可出現(xiàn)新發(fā)EGV或者EGV加重,甚至快速進展為肝硬化。4.抗病毒治療的CHB患者EGV大多數(shù)無變化,極少數(shù)患者出現(xiàn)病情進展。5.監(jiān)測EUS變化對于評估慢性肝病患者病情進展及預后具有一定臨床意義。6.EUS對于食管黏膜下靜脈曲張檢出率比門脈CTA更高。EUS與門脈CTA對于食管外周靜脈曲張、胃底黏膜下靜脈靜脈曲張及胃底外周靜脈靜脈曲張的檢出率高度一致。
[Abstract]:Purpose 1. To evaluate the value of EUS on the early diagnosis of esophageal varices (EGV) in patients with liver cirrhosis and chronic hepatitis B (CHB). EUS was followed up for enrolled patients to understand the changes in EGV and to assess the prognosis. To study the consistency of EUS and gated CT angiography (CTA) in the diagnosis of liver cirrhosis. Method 1. EUS was used to test 116 patients with liver cirrhosis and 182 patients with CHB who had not seen EGV in 116 cases of gastroscope. The liver cirrhosis group was divided into 3 groups according to the Child-Pugh classification, and the CHB group was divided into two groups according to whether the anti-virus treatment was performed. After 1 year, the EUS was reexamined for all the enrolled patients, and the change of EGV before and after follow-up was analyzed. Eighty-four patients with liver cirrhosis were selected as the subject of the study, and the results of EUS and CTA on the detection of the submucosal and peripheral varices of the esophagus and the submucous membrane of the esophagus were summarized. Results 1. In the group of liver cirrhosis, in 101 patients, more than one part of the gastric oesophageal varices were detected, and in 68 patients, more than two parts of the gastric oesophageal varices were detected. In 21 patients, the esophageal mucosa and the esophageal varices were detected at the same time, and 30 patients were able to detect both the submucosal and the bottom of the stomach at the same time. weekly varices. There was a significant difference in the detection of the varices of the esophagus and the submucous membrane of the stomach, the varices of the esophagus and the bottom of the stomach, the esophageal and the perigastric varices in the group of liver cirrhosis and the group of CHB (P0.05). The difference between the two groups was statistically significant (P0.05). After 1 year, EUS was re-examined. In the patients with liver cirrhosis, there were no significant changes in the varicose veins in 68 patients with Child A, 6 cases of varicosis or reduction of varicosity in 6 cases, and 1 case with Child-A progression to Child C. 8 patients with Child B grade increased varicosity, 5 patients found a new varicose vein. 4 cases of Child C grade patient's vein The degree of tension increased, and 2 patients found a new varicose vein. 4. The anti-virus group of HBV and 23 cases of varicosity were reduced or resolved. No anti-virus group, 4 patients with varicose veins increased, 6 patients had a new varicosity, 1 patient progressed to Child A grade of cirrhosis, and 5. EUS did not have a high degree of consistency in the detection of varicose veins in the esophageal mucosa (P0.05). For the peripheral vein of the esophagus, the lower submucosal vein of the stomach and the peripheral vein of the bottom of the stomach, the EUS and the gate vein CTA had a high degree of consistency in the detection rate of the varicosity (P0.05). Conclusion 1. EUS can find esophageal and gastric submucosal varicose veins and peripheral varices for cirrhosis and CHB group without varicosity under gastroscope. The anti-virus therapy can delay the development of the cirrhosis of the liver cirrhosis, and the varicose veins of the patients with early hepatic fibrosis can be reversed to a certain degree by the anti-virus treatment. However, for Child B-C patients, it is still not possible to completely block varicose veins even if antiviral therapy is performed. In patients with CHB without anti-viral treatment, new EGV or EGV exacerbation may occur, even with rapid progression to cirrhosis. The majority of the patients with CHB in the anti-viral treatment did not change, and a very small number of patients had a disease progression. The monitoring of EUS changes has a certain clinical significance for assessing the progress and prognosis of patients with chronic liver disease. EUS and gate-vein CTA were highly consistent with the rate of varicose veins of the esophagus, the varicose veins of the submucous membrane of the stomach and the varicose veins of the peripheral veins of the bottom of the stomach.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R575.2
本文編號：2387516
[Abstract]:Purpose 1. To evaluate the value of EUS on the early diagnosis of esophageal varices (EGV) in patients with liver cirrhosis and chronic hepatitis B (CHB). EUS was followed up for enrolled patients to understand the changes in EGV and to assess the prognosis. To study the consistency of EUS and gated CT angiography (CTA) in the diagnosis of liver cirrhosis. Method 1. EUS was used to test 116 patients with liver cirrhosis and 182 patients with CHB who had not seen EGV in 116 cases of gastroscope. The liver cirrhosis group was divided into 3 groups according to the Child-Pugh classification, and the CHB group was divided into two groups according to whether the anti-virus treatment was performed. After 1 year, the EUS was reexamined for all the enrolled patients, and the change of EGV before and after follow-up was analyzed. Eighty-four patients with liver cirrhosis were selected as the subject of the study, and the results of EUS and CTA on the detection of the submucosal and peripheral varices of the esophagus and the submucous membrane of the esophagus were summarized. Results 1. In the group of liver cirrhosis, in 101 patients, more than one part of the gastric oesophageal varices were detected, and in 68 patients, more than two parts of the gastric oesophageal varices were detected. In 21 patients, the esophageal mucosa and the esophageal varices were detected at the same time, and 30 patients were able to detect both the submucosal and the bottom of the stomach at the same time. weekly varices. There was a significant difference in the detection of the varices of the esophagus and the submucous membrane of the stomach, the varices of the esophagus and the bottom of the stomach, the esophageal and the perigastric varices in the group of liver cirrhosis and the group of CHB (P0.05). The difference between the two groups was statistically significant (P0.05). After 1 year, EUS was re-examined. In the patients with liver cirrhosis, there were no significant changes in the varicose veins in 68 patients with Child A, 6 cases of varicosis or reduction of varicosity in 6 cases, and 1 case with Child-A progression to Child C. 8 patients with Child B grade increased varicosity, 5 patients found a new varicose vein. 4 cases of Child C grade patient's vein The degree of tension increased, and 2 patients found a new varicose vein. 4. The anti-virus group of HBV and 23 cases of varicosity were reduced or resolved. No anti-virus group, 4 patients with varicose veins increased, 6 patients had a new varicosity, 1 patient progressed to Child A grade of cirrhosis, and 5. EUS did not have a high degree of consistency in the detection of varicose veins in the esophageal mucosa (P0.05). For the peripheral vein of the esophagus, the lower submucosal vein of the stomach and the peripheral vein of the bottom of the stomach, the EUS and the gate vein CTA had a high degree of consistency in the detection rate of the varicosity (P0.05). Conclusion 1. EUS can find esophageal and gastric submucosal varicose veins and peripheral varices for cirrhosis and CHB group without varicosity under gastroscope. The anti-virus therapy can delay the development of the cirrhosis of the liver cirrhosis, and the varicose veins of the patients with early hepatic fibrosis can be reversed to a certain degree by the anti-virus treatment. However, for Child B-C patients, it is still not possible to completely block varicose veins even if antiviral therapy is performed. In patients with CHB without anti-viral treatment, new EGV or EGV exacerbation may occur, even with rapid progression to cirrhosis. The majority of the patients with CHB in the anti-viral treatment did not change, and a very small number of patients had a disease progression. The monitoring of EUS changes has a certain clinical significance for assessing the progress and prognosis of patients with chronic liver disease. EUS and gate-vein CTA were highly consistent with the rate of varicose veins of the esophagus, the varicose veins of the submucous membrane of the stomach and the varicose veins of the peripheral veins of the bottom of the stomach.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R575.2
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