内镜超声观察门静脉高压症时胸导管的形态

Observation of thoracic duct morphology in portal hypertension by endoscopic ultrasound.

作者信息

Parasher V K, Meroni E, Malesci A, Spinelli P, Tommasini M A, Markert R, Bhutani M S

机构信息

Beebe Medical Center, Lewes, Delaware; Istituto Clinico Humanitas and Nazionale Tumori, Milan, Italy.

出版信息

Gastrointest Endosc. 1998 Dec;48(6):588-92. doi: 10.1016/s0016-5107(98)70040-9.

DOI:10.1016/s0016-5107(98)70040-9

PMID:9852448

Abstract

BACKGROUND

Thoracic duct dilation has been demonstrated in portal hypertension and hepatic cirrhosis by lymphangiography and laparotomy and at autopsy. It is thought to be secondary to increased hepatic lymph flow and has been described in the absence of ascites or esophageal varices. The aim of the present study was to observe thoracic duct morphology by endoscopic ultrasound in various subsets of patients with portal hypertension and hepatic cirrhosis and also to validate existing radiologic/surgical data.

METHODS

The thoracic duct of 33 patients with cirrhosis and portal hypertension was studied by endoscopic ultrasound. Patients were divided into four groups: 1, patients with ascites and esophageal varices; 2, esophageal varices without ascites; 3, without esophageal varices or ascites; 4, extrahepatic portal hypertension due to pancreatic malignancy. The thoracic duct diameter was also measured in 14 control subjects (group 5).

RESULTS

When the thoracic duct diameter for the five groups was compared with analysis of variance, significance was p < 0.0001; by pairwise comparison, group 1 differed from the other four groups (p < 0.05). Thoracic duct dilation (5.61 mm) was seen in group 1 patients, whereas no dilation was present in groups 2 through 4. Additionally, thoracic duct diameter in 33 portal hypertensive and/or cirrhotic patients was significantly different from that in the 14 control subjects (p = 0. 003).

CONCLUSION

The thoracic duct can be reliably identified by EUS in patients with hepatic cirrhosis and portal hypertension. Dilation of the duct is seen only in patients with hepatic cirrhosis, ascites, and esophageal varices. No thoracic duct dilation is present in extrahepatic portal hypertension. Contrary to existing radiologic/surgical data, thoracic duct dilation is not seen in all patients with hepatic cirrhosis and portal hypertension signifying advanced disease. A dilated thoracic duct by endoscopic ultrasound should be considered yet another sign of portal hypertension.

摘要

背景

通过淋巴管造影、剖腹手术及尸检已证实，门静脉高压症和肝硬化患者存在胸导管扩张。其被认为是肝淋巴流量增加的继发性结果，且在无腹水或食管静脉曲张的情况下也有相关描述。本研究的目的是通过内镜超声观察门静脉高压症和肝硬化各亚组患者的胸导管形态，并验证现有的放射学/外科数据。

方法

对33例肝硬化和门静脉高压症患者的胸导管进行内镜超声检查。患者分为四组：1. 有腹水和食管静脉曲张的患者；2. 无腹水的食管静脉曲张患者；3. 无食管静脉曲张或腹水的患者；4. 因胰腺恶性肿瘤导致的肝外门静脉高压症患者。还对14名对照受试者（第5组）测量了胸导管直径。

结果

通过方差分析比较五组的胸导管直径，p < 0.0001，具有显著性差异；通过两两比较，第1组与其他四组不同（p < 0.05）。第1组患者可见胸导管扩张（5.61毫米），而第2至4组未见扩张。此外，33例门静脉高压症和/或肝硬化患者的胸导管直径与14名对照受试者的胸导管直径有显著差异（p = 0.003）。