Shen Shao-Hua, Liu Ying-Di, Sun Xiao, Li Meng, Sun Guo-Hui, Wang Juan, Liu Jiang-Tao, Tie Jun, Yang Jing
Department of Gastroenterology and Hepatology, PLA General Hospital, Beijing 100853, P.R. China.
Department of Gastroenterology, Hainan Branch of PLA General Hospital, Sanya, Hainan 572000, P.R. China.
Exp Ther Med. 2017 Sep;14(3):2261-2264. doi: 10.3892/etm.2017.4727. Epub 2017 Jul 9.
The aim of the present study was to investigate the predilection position of hemorrhagic stigmata (HS) in patients with esophageal variceal hemorrhage and provide guidance on endoscopic therapy for esophageal varices. The clinical characteristics, particularly the endoscopic manifestations of HS, in the patients who presented with gastroesophageal variceal hemorrhage and cirrhosis between January 2003 and December 2013 at our hospital were summarized and patients were grouped according to the distance of the lesion site to incisors at 35-40 and ~30 cm. The association between the location of HS and active hemorrhage was assessed. The location of hemorrhage and HS at 35-40 cm from the incisors was more common in esophageal varices patients, followed by the location at ~30 cm from the incisors (P<0.0001). The incidence of HS in esophageal varices patients in the 35-40 cm group was significantly higher than that in the ~30 cm group except for HS at 9:00 position (P<0.0001). The highest incidence of HS in the ~30 cm group was at the 3:00 position, followed by the 12:00, 6:00 and 9:00 position. Among them, there were significant differences between the 3:00 and 6:00 position, the 3:00 and 9:00 position, and the 9:00 and 12:00 position (P<0.05). The order in the 35-40 cm group was similar to that in the ~30 cm group and the incidence of HS at the 9:00 position was lowest (P<0.05). A certain association between the point of location of HS and hemorrhage was identified. HS located at 35-40 cm from the lesion site to incisors was identified to be most likely to bleed, followed by that located at ~30 cm. In addition, the incidence of HS at 9:00 position was found to be lower than that in the other positions. Therefore, HS located at ~30 cm and 35-40 cm from the lesion site to incisors should be paid attention to and the 3:00, 12:00 and 6:00 rather than the 9:00 position should be prioritized during endoscopic treatment, particularly in emergency situations.
本研究旨在探讨食管静脉曲张出血患者出血性痕迹（HS）的好发部位，并为食管静脉曲张的内镜治疗提供指导。总结了2003年1月至2013年12月在我院就诊的胃食管静脉曲张出血并肝硬化患者的临床特征，尤其是HS的内镜表现，并根据病变部位距门齿的距离分为35 - 40 cm组和30 cm组。评估了HS位置与活动性出血之间的关联。食管静脉曲张患者中，距门齿35 - 40 cm处出血和HS的位置更为常见，其次是距门齿30 cm处（P<0.0001）。除9:00位置的HS外，35 - 40 cm组食管静脉曲张患者HS的发生率显著高于30 cm组（P<0.0001）。30 cm组HS发生率最高的是3:00位置，其次是12:00、6:00和9:00位置。其中，3:00与6:00位置、3:00与9:00位置以及9:00与12:00位置之间存在显著差异（P<0.05）。35 - 40 cm组的顺序与30 cm组相似，9:00位置HS的发生率最低（P<0.05）。确定了HS的位置点与出血之间存在一定关联。发现距病变部位至门齿35 - 40 cm处的HS最易出血，其次是距门齿30 cm处的HS。此外，发现9:00位置HS的发生率低于其他位置。因此，应关注距病变部位至门齿~30 cm和35 - 40 cm处的HS，在内镜治疗时，尤其是在紧急情况下，应优先处理3:00、12:00和6:00位置，而非9:00位置。
