Shirai Z
First Department of Surgery, School of Medicine, Fukuoka University, Japan.
Nihon Geka Gakkai Zasshi. 1993 Feb;94(2):165-76.
The relationship between endoscopic findings and hemodynamics was studied in 262 patients. The endoscopic findings were classified into 3 groups; 1) Type 1: case with esophageal varices. 2) Type 2: case with esophago-cardiac varices. 3) Type 3: case with fundic varices. The hemodynamics were examined using late phase venography after conventional abdominal angiography. The blood vessels of type 1 resembled those of type 2, and 72% of the cardiac varices were connected with esophageal varices. On the other hand, the blood vessels of type 3 were completely different from those of type 1 and type 2, and 84% of the fundic varices were connected with large gastro-renal shunts. From these results, I have been applying endoscopic in injection sclerotherapy for types 1 and 2, and Hassab's operation for type 3. The rates of hemostasis were 100%, 93% and 100% in types 1, 2 and 3, respectively. The rates of disappearance of the varices after treatment were 78.7%, 87% and 100% in types 1, 2 and 3, respectively. It is concluded that good therapeutic results can be obtained when an appropriate therapeutic method is selected. Treatment should be based on the hemodynamics associated with the endoscopic findings of esophago-gastric varices.
对262例患者的内镜检查结果与血流动力学之间的关系进行了研究。内镜检查结果分为3组：1）1型：食管静脉曲张病例。2）2型：食管-贲门静脉曲张病例。3）3型：胃底静脉曲张病例。在常规腹部血管造影后，采用晚期静脉造影检查血流动力学。1型的血管与2型相似，72%的贲门静脉曲张与食管静脉曲张相连。另一方面，3型的血管与1型和2型完全不同，84%的胃底静脉曲张与大的胃-肾分流相连。根据这些结果，我一直对1型和2型采用内镜注射硬化疗法，对3型采用哈萨布手术。1型、2型和3型的止血率分别为100%、93%和100%。治疗后静脉曲张消失率在1型、2型和3型中分别为78.7%、87%和100%。得出结论，当选择合适的治疗方法时，可以获得良好的治疗效果。治疗应基于与食管胃静脉曲张内镜检查结果相关的血流动力学。
