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内镜超声检查预测肝硬化患者早期食管静脉曲张出血：一例报告。

Endoscopic ultrasonography predicts early esophageal variceal bleeding in liver cirrhosis: A case report.

作者信息

Men Changjun, Zhang Guoliang

机构信息

Digestive Department, Tianjin First Center Hospital, Tianjin, P.R. China.

出版信息

Medicine (Baltimore). 2017 Apr;96(17):e6749. doi: 10.1097/MD.0000000000006749.

DOI:10.1097/MD.0000000000006749
PMID:28445299
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5413264/
Abstract

RATIONALE

Bleeding esophageal and gastric varices constitute a serious complication in liver cirrhosis. Previous studies have shown that endoscopic ultrasonography (EUS) can be used to predict early esophageal variceal bleeding in liver cirrhosis.

PATIENT CONCERNS

We report a case of a 46-year-old man with hepatitis B liver cirrhosis (CTP score, 5; Child-Pugh class, A) who was admitted to our hospital due to a decreased appetite lasting 1 week.

DIAGNOSIS

He was initially diagnosed with decompensated hepatitis B cirrhosis; an abdominal computed tomography (CT) scan indicated a diagnosis of liver cirrhosis and portal hypertension (PHT).

INTERVENTIONS

Common endoscopic examination showed no evidence of gastroesophageal varices; EUS revealed distinct varices of the esophageal and gastric veins. Six months after discharge, the patient was rehospitalized because of upper gastrointestinal bleeding. Endoscopic ligation was implemented as well as esophageal varices loop ligature (EVL).

OUTCOMES

Six months later, EUS showed obvious collateral and perforator veins.

LESSONS

We should strongly recommend that patients with liver cirrhosis undergo EUS in addition to a routine endoscopic examination. EUS can play an important role in evaluating the risk for bleeding in PHT and can be used to assess the efficacy of EVL.

摘要

理论依据

食管和胃静脉曲张破裂出血是肝硬化的严重并发症。既往研究表明，内镜超声检查（EUS）可用于预测肝硬化患者早期食管静脉曲张出血。

患者情况

我们报告一例46岁男性乙肝肝硬化患者（CTP评分5分；Child-Pugh分级为A级），因食欲减退持续1周入院。

诊断

最初诊断为失代偿期乙肝肝硬化；腹部计算机断层扫描（CT）显示肝硬化和门静脉高压（PHT）。

干预措施

普通内镜检查未发现食管胃静脉曲张；EUS显示食管和胃静脉有明显曲张。出院6个月后，患者因上消化道出血再次住院。实施了内镜下套扎术及食管静脉曲张套扎术（EVL）。

结果

6个月后，EUS显示有明显的侧支静脉和穿支静脉。

经验教训

我们强烈建议肝硬化患者除进行常规内镜检查外，还应接受EUS检查。EUS在评估PHT出血风险方面可发挥重要作用，并可用于评估EVL的疗效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7d8/5413264/c5e527d4462c/medi-96-e6749-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7d8/5413264/c6dc75e31b57/medi-96-e6749-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7d8/5413264/045ec86c5895/medi-96-e6749-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7d8/5413264/c85024e22f33/medi-96-e6749-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7d8/5413264/c5e527d4462c/medi-96-e6749-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7d8/5413264/c6dc75e31b57/medi-96-e6749-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7d8/5413264/045ec86c5895/medi-96-e6749-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7d8/5413264/c85024e22f33/medi-96-e6749-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7d8/5413264/c5e527d4462c/medi-96-e6749-g004.jpg

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