Tabibian N, Graham D Y
J Clin Gastroenterol. 1987 Jun;9(3):279-82. doi: 10.1097/00004836-198706000-00007.
Many claim that upper gastrointestinal hemorrhage in patients with varices is frequently not of variceal origin. Such teaching is contrary to our experience. We therefore reviewed the records of 127 consecutive patients with 165 episodes of acute upper gastrointestinal bleeding who were found to have esophageal varices by endoscopy. Varices were the only potential site of the index bleed in 101 of the 127 patients (79.5%). In addition to varices, other potential sites of bleeding were gastric ulcer in 9 (7%), Mallory-Weiss tear in 4 (3.1%), duodenal ulcer in 3 (2.3%), and multiple gastroduodenal erosions in 10 (7.8%). We used the characteristics of the clinical presentation (e.g., varix seen bleeding) and the known natural course of the variceal bleeding to attempt to define the site of bleeding in the group with more than one potential site. In 15 we could make a judgment as to the likely source: In 9 it was variceal and in 6 nonvariceal. When varices are seen at endoscopy in a patient with a major hemorrhage, they are responsible for the bleeding in greater than 80% of cases.
许多人声称，静脉曲张患者的上消化道出血往往并非源于静脉曲张。这种说法与我们的经验相悖。因此，我们回顾了127例连续患者的记录，这些患者共有165次急性上消化道出血发作，经内镜检查发现患有食管静脉曲张。在127例患者中，有101例（79.5%）静脉曲张是此次出血的唯一潜在部位。除静脉曲张外，其他潜在出血部位包括胃溃疡9例（7%）、马洛里-魏斯撕裂4例（3.1%）、十二指肠溃疡3例（2.3%）以及多发胃十二指肠糜烂10例（7.8%）。我们利用临床表现的特征（如可见静脉曲张出血）以及已知的静脉曲张出血自然病程，试图确定有多个潜在出血部位的患者群体中的出血部位。在15例患者中，我们能够判断出可能的出血源：9例为静脉曲张出血，6例为非静脉曲张出血。在内镜检查中发现静脉曲张的大出血患者中，超过80%的病例出血是由静脉曲张引起的。
