Tayama C, Iwao T, Oho K, Toyonaga A, Tanikawa K
Dept. of Medicine II, Kurume University School of Medicine, Japan.
Endoscopy. 1998 Jan;30(1):25-31. doi: 10.1055/s-2007-993724.
BACKGROUNDS AND STUDY AIMS: Effect of endoscopic variceal ligation (EVL) on gastric mucosal hemodynamics would differ in patients with and without large fundal varices. The aim of this study was to test this hypothesis.
Twenty-seven patients with cirrhosis and large sized esophageal varices were prospectively studied. There were eight patients with large fundal varices and 19 patients without large fundal varices. Before EVL, gastric mucosal hemodynamics were endoscopically assessed by laser-Doppler velocimetry and reflectance spectrophotometry in the antrum and the corpus. In the reflectance spectrophotometric measurements, gastric mucosal hemoglobin content (IHb) and gastric mucosal oxygen saturation (ISO2) were determined. The severity of portal-hypertensive gastropathy (PHG) was also recorded at the antrum and the corpus. For data analysis, PHG was scored (absent, 0; mild, 1; severe, 2; bleeding, 3). These measurements were repeated after initial (three days after initial session) and repeated (seven days after last session) EVL.
At the antrum, neither PHG score nor gastric mucosal hemodynamic parameters were modified after initial and repeated EVL in patients with and without large fundal varices. In addition, no significant differences of the integrated changes in PHG score and gastric mucosal hemodynamic parameters were observed in the two groups. At the corpus, PHG score significantly increased after initial and repeated EVL in patients without large fundal varices. In these patients, laser-Doppler signal and ISO2 significantly decreased and IHb significantly increased after initial and repeated EVL. In contrast, PHG score, laser-Doppler signal, and ISO2 did not change significantly in patients with large fundal varices, although IHb transiently increased after initial EVL. Furthermore, the integrated changes in PHG score and gastric mucosal hemodynamic parameters were significantly lower in patients with large fundal varices than in those without.
The aggravation of PHG after EVL is due to congestion of the gastric mucosal circulation. The presence of large fundal varices plays a protective role in the development of EVL-induced gastric mucosal hemodynamic derangement.
背景与研究目的：内镜下静脉曲张结扎术（EVL）对胃黏膜血流动力学的影响在有和没有胃底大静脉曲张的患者中可能不同。本研究的目的是验证这一假设。
对27例肝硬化和大型食管静脉曲张患者进行前瞻性研究。其中8例有胃底大静脉曲张，19例无胃底大静脉曲张。在进行EVL之前，通过激光多普勒测速仪和反射分光光度法在内镜下评估胃窦和胃体的胃黏膜血流动力学。在反射分光光度测量中，测定胃黏膜血红蛋白含量（IHb）和胃黏膜氧饱和度（ISO2）。同时记录胃窦和胃体处门静脉高压性胃病（PHG）的严重程度。数据分析时，对PHG进行评分（无，0；轻度，1；重度，2；出血，3）。在初次（初次治疗后3天）和重复（最后一次治疗后7天）EVL后重复这些测量。
在胃窦处，有和没有胃底大静脉曲张的患者在初次和重复EVL后，PHG评分和胃黏膜血流动力学参数均未改变。此外，两组在PHG评分和胃黏膜血流动力学参数的综合变化方面未观察到显著差异。在胃体处，无胃底大静脉曲张的患者在初次和重复EVL后PHG评分显著增加。在这些患者中，初次和重复EVL后激光多普勒信号和ISO2显著降低，IHb显著增加。相比之下，有胃底大静脉曲张的患者，尽管初次EVL后IHb短暂升高，但PHG评分、激光多普勒信号和ISO2没有明显变化。此外，有胃底大静脉曲张的患者在PHG评分和胃黏膜血流动力学参数的综合变化明显低于无胃底大静脉曲张的患者。
EVL后PHG的加重是由于胃黏膜循环充血。胃底大静脉曲张的存在对EVL诱导的胃黏膜血流动力学紊乱的发展起保护作用。
