内镜下静脉曲张结扎术对门静脉系统压力的影响。

The impact of endoscopic variceal ligation on the pressure of the portal venous system.

作者信息

Lo G H, Liang H L, Lai K H, Chang C F, Hwu J H, Chen S M, Lin C K, Chiang H T

机构信息

Department of Medicine and Department of Radiology, National Yang-Ming Medical College, Taipei, Taiwan.

出版信息

J Hepatol. 1996 Jan;24(1):74-80. doi: 10.1016/s0168-8278(96)80189-9.

DOI:10.1016/s0168-8278(96)80189-9

PMID:8834028

Abstract

BACKGROUND/AIMS: Endoscopic variceal ligation is a viable substitute for injection sclerotherapy. It is still not known how endoscopic variceal ligation may influence the portal venous system. To clarify this issue we investigated the impact of endoscopic variceal ligation on the pressure of the portal venous system.

METHODS

Twenty-nine patients with a history of esophageal variceal bleeding but without ascites were enrolled. All had cirrhosis; 63% of them were post-hepatitic. Ligation was performed at intervals of 2-3 weeks until all the varices were obliterated. Portal venograms were performed before institution of ligation and after variceal obliteration to assess venographic findings and pressure changes. The pressures of the main portal vein, splenic vein and superior mesenteric vein were recorded.

RESULTS

Twenty-five patients completed the study. A mean of 4.4 sessions (range: 2-7) of ligation over a period of 2 months was needed. Seventeen (68%) patients experienced elevated pressure and eight (32%) patients reduced pressure after ligation. Mean (median) pressure changes were as follows: portal venous pressure, 26.5 +/- 4.7 (25.0) mmHg vs. 28.2 +/- 7.2 (28.0) mmHg (p > 0.05); splenic venous pressure, 28.2 +/- 4.9 (26.0) mmHg vs. 29.0 +/- 6.8 (29.0) mmHg (p > 0.05); superior mesenteric venous pressure, 28.4 +/- 6.0 (27.0) mmHg vs. 29.5 +/- 7.0 (29.0) mmHg (p > 0.05). Five patients (20%) experienced rebleeding before variceal obliteration; all of them presented elevated portal pressures after variceal obliteration. Among the eight patients with decreased portal pressure, seven (87%) had other major collaterals apart from esophageal varices, compared to three out of the 17 (18%) patients with elevated portal pressure who had other major collaterals (p < 0.01).

CONCLUSIONS

Among patients receiving endoscopic variceal ligation, 68% experienced elevated portal pressure, while 32% had decreased portal pressure. Elevation of portal pressure after variceal ligation may be an important factor in variceal rebleeding. The presence of other major collaterals apart from esophageal varices may be responsible for the decrease in portal pressure after obliteration of esophagel varices.

摘要

背景/目的：内镜下静脉曲张结扎术是注射硬化疗法的一种可行替代方法。目前尚不清楚内镜下静脉曲张结扎术如何影响门静脉系统。为阐明这一问题，我们研究了内镜下静脉曲张结扎术对门静脉系统压力的影响。

方法

纳入29例有食管静脉曲张出血史但无腹水的患者。所有患者均患有肝硬化；其中63%为肝炎后肝硬化。每隔2 - 3周进行一次结扎，直至所有静脉曲张消失。在结扎前及静脉曲张消失后进行门静脉造影，以评估静脉造影结果和压力变化。记录门静脉、脾静脉和肠系膜上静脉的压力。

结果

25例患者完成了研究。在2个月的时间里平均需要进行4.4次（范围：2 - 7次）结扎。17例（68%）患者结扎后压力升高，8例（32%）患者压力降低。平均（中位数）压力变化如下：门静脉压力，26.5±4.7（25.0）mmHg对28.2±7.2（28.0）mmHg（p>0.05）；脾静脉压力,28.2±4.9（26.0）mmHg对29.0±6.8（29.0）mmHg（p>0.05）；肠系膜上静脉压力，28.4±6.0（27.0）mmHg对29.5±7.0（29.0）mmHg（p>0.05）。5例（20%）患者在静脉曲张消失前再次出血；所有这些患者在静脉曲张消失后门静脉压力均升高。在门静脉压力降低的8例患者中，7例（87%）除食管静脉曲张外还有其他主要侧支循环，而在门静脉压力升高的17例患者中有3例（18%）有其他主要侧支循环（p<0.01）。