超声内镜对食管胃底静脉曲张诊断价值及与多层螺旋CT血管造影诊断比较
发布时间：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)患者超声内镜(endoscopic ultrasonography,EUS)下胃底食管静脉曲张(esophageal and gastric varices,EGV)各部位检出情况,评估EUS对EGV的早期诊断价值。通过EUS对于入组患者进行随访,了解EGV变化,评估预后。2.探讨EUS与门脉CT血管造影(Computed Tomography Angiography,CTA)在肝硬化患者EGV诊断方面的一致性。方法1.采用EUS对116例胃镜下未见EGV的乙肝后肝硬化患者及182例CHB患者进行检测,按照曲张静脉的部位及程度进行分级,分析两组患者食管胃底各部位静脉曲张及穿通支的检出情况。2.肝硬化组按照Child-Pugh分级分成3组,CHB组按照是否抗病毒治疗分为2组,1年后对所有入组患者复查EUS,分析随访前后EGV变化情况。3.选取84例肝硬化患者做为研究对象,总结EUS及CTA对食管胃底粘膜下及外周静脉曲张检出情况,比较两者诊断方面的一致性。结果1.肝硬化组中,101例患者可检出多于一个部位的胃食管外周静脉曲张,68例患者可检出两个以上部位胃食管外周静脉曲张,21例患者同时检出食管黏膜下及食管外周静脉曲张,30例患者可同时检出胃底粘膜下及胃底外周静脉曲张。2.肝硬化组与CHB组相比,食管及胃底黏膜下静脉曲张、食管及胃底旁静脉曲张、食管及胃底周围静脉曲张检出情况差异均有统计学意义(P0.05)。两组患者穿通支检出情况相比,差异有统计学意义(P0.05)。3.1年后再次复查EUS,肝硬化患者中,68例Child A级患者各部位静脉曲张未见明显变化,6例患者静脉曲张消退或减轻,1例患者由Child A级进展为Child C级。8例Child B级患者静脉曲张程度加重,5例患者发现新的静脉曲张。4例Child C级患者静脉曲张程度加重,2例患者发现新的静脉曲张。4.HBV抗病毒组,23例静脉曲张程度减轻或消退。未抗病毒组,4例患者静脉曲张程度加重,6例患者出现新发静脉曲张,1例患者进展为肝硬化Child A级。5.EUS与门脉CTA相比,对于食管黏膜下静脉曲张检出不具有高度一致性(P0.05)。对于食管外周静脉、胃底黏膜下静脉及胃底外周静脉,EUS与门脉CTA在静脉曲张检出率方面具有高度一致性(P0.05)。结论1.对于在胃镜下未见到静脉曲张的肝硬化及CHB群体而言,EUS可以发现食管胃底黏膜下静脉曲张及外周静脉曲张,对更早期诊断肝硬化及区分病情程度具有意义。2.抗病毒治疗可以延缓肝硬化静脉曲张的进展,通过抗病毒治疗可使部分早期肝纤维化患者静脉曲张得到一定程度逆转。但对于Child B-C级患者,即使进行抗病毒治疗,仍然不能完全阻止静脉曲张加重。3.未抗病毒治疗的CHB患者,可出现新发EGV或者EGV加重,甚至快速进展为肝硬化。4.抗病毒治疗的CHB患者EGV大多数无变化,极少数患者出现病情进展。5.监测EUS变化对于评估慢性肝病患者病情进展及预后具有一定临床意义。6.EUS对于食管黏膜下静脉曲张检出率比门脉CTA更高。EUS与门脉CTA对于食管外周静脉曲张、胃底黏膜下静脉静脉曲张及胃底外周静脉静脉曲张的检出率高度一致。
[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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2
本文编号：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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2
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