Yeo W, Sung J Y, Ward S C, Chung S C, Lee W Y, Li A K, Johnson P J
Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
Dig Dis Sci. 1995 Dec;40(12):2516-21. doi: 10.1007/BF02220435.
Our purpose was to determine, in a prospective study, the causes of gastrointestinal hemorrhage in patients with hepatocellular carcinoma, and the relationship of portal vein invasion with variceal hemorrhage in these patients. During an 11-month period, 55 patients presented with hepatocellular carcinoma presented with signs and/or symptoms of upper gastrointestinal hemorrhage. Forty-seven percent had bleeding from varices, whereas the majority, 53%, had a nonvariceal bleeding source. Among those with nonvariceal bleeding, duodenal ulceration was the commonest cause. Direct tumor invasion into the gastrointestinal tract was found in three patients. Tumor invasion of the portal venous system was detected by ultrasound examination in 76% of the variceal bleeders, compared to only 45% of the nonvariceal bleeders. Despite the very high frequency of cirrhosis among patients with hepatocellular carcinoma, the source of bleeding was variceal in less than half of the patients. Portal vein invasion is a risk factor for subsequent variceal bleed.
我们的目的是在一项前瞻性研究中确定肝细胞癌患者胃肠道出血的原因，以及这些患者门静脉侵犯与静脉曲张出血之间的关系。在11个月的时间里，55例肝细胞癌患者出现上消化道出血的体征和/或症状。47%的患者出血来自静脉曲张，而大多数（53%）有非静脉曲张出血源。在非静脉曲张出血患者中，十二指肠溃疡是最常见的原因。3例患者发现肿瘤直接侵犯胃肠道。超声检查发现76%的静脉曲张出血患者有门静脉系统肿瘤侵犯，而非静脉曲张出血患者中这一比例仅为45%。尽管肝细胞癌患者中肝硬化的发生率很高，但不到一半的患者出血源是静脉曲张。门静脉侵犯是随后发生静脉曲张出血的一个危险因素。
