Watanabe K, Kimura K, Matsutani S, Ohto M, Okuda K
First Department of Medicine, Chiba University School of Medicine, Japan.
Gastroenterology. 1988 Aug;95(2):434-40. doi: 10.1016/0016-5085(88)90501-x.
The hemodynamic features of gastric varices are not well documented. The purpose of this study was to investigate the nature of hepatofugal collateral veins, their origins, the direction of blood flow in the major veins and collateral veins, and portal venous pressure. To this end, 230 patients, mostly cirrhotic, who had esophageal or gastric varices, or both, demonstrated by endoscopy were investigated by portal vein catheterization. The findings were correlated with endoscopically assessed degrees of varices. Gastric varices were seen in 57% of the patients with varices due to portal hypertension. In most of the patients with advanced gastric varices, esophageal varices were minimal or absent. When patients with gastric varices were compared with those having predominantly esophageal varices, it was found that advanced gastric varices were more frequently supplied by the short and posterior gastric veins, they were almost always associated with large gastrorenal shunts, and portal venous pressure in patients with large gastric varices was lower. Chronic portal systemic encephalopathy was more common in patients with large gastric varices due to hepatofugal flow of superior mesenteric venous blood in the splenic vein than in patients with predominantly esophageal varices. Thus, the hemodynamics in patients with large gastric varices are distinctly different from those in patients with mainly esophageal varices, and such differences seem to account for the differing incidence of chronic encephalopathy and variceal bleeding.
胃静脉曲张的血流动力学特征尚无充分记录。本研究的目的是调查肝外分流静脉的性质、其起源、主要静脉和侧支静脉中的血流方向以及门静脉压力。为此，对230例经内镜检查显示有食管或胃静脉曲张或两者皆有的患者（大多数为肝硬化患者）进行门静脉插管研究。研究结果与内镜评估的静脉曲张程度相关。在因门静脉高压导致静脉曲张的患者中，57%可见胃静脉曲张。在大多数晚期胃静脉曲张患者中，食管静脉曲张轻微或不存在。将胃静脉曲张患者与主要为食管静脉曲张的患者进行比较时发现，晚期胃静脉曲张更常由胃短静脉和胃后静脉供血，它们几乎总是与大的胃肾分流相关，且大胃静脉曲张患者的门静脉压力较低。由于肠系膜上静脉血经脾静脉向肝外流动，慢性门静脉系统脑病在大胃静脉曲张患者中比主要为食管静脉曲张的患者更常见。因此，大胃静脉曲张患者的血流动力学与主要为食管静脉曲张的患者明显不同，这种差异似乎解释了慢性脑病和静脉曲张出血的不同发生率。
