摘要
目的研究Ｂ超显像预测门脉高压上消化道出血的危险性．方法１９９０年～１９９６年采用Ｂ型超声诊断仪探测１４２例（非出血组１０８例，出血级３４例）肝炎后肝硬变患者肝门静脉、脾门静脉的直径，并与慢性肝炎７５例作为对照．结果肝门静脉、脾门静脉直径与食管胃底静脉曲张发生率有关．肝硬变上消化道出血组肝门静脉（１５１ｃｍ±０２０ｃｍ）、脾门静脉（１１８ｃｍ±０２８ｃｍ）直径明显大于肝硬变非出血组（１１９ｃｍ±０２３ｃｍ，０９４ｃｍ±０１８ｃｍ，Ｐ＜００１）．肝门静脉、脾门静脉直径与上消化道出血率呈正相关（ｒ＝０９９，Ｐ＜００１）．肝门静脉≥１５ｃｍ，脾门静脉≥１１ｃｍ，可作为预测上消化道出血的警戒线．２２例门脉高压患者应用普鲁纳洛治疗，治疗后显示肝门静脉、脾门静脉直径较前缩小．结论应用Ｂ超显像测定静脉直径可预测肝硬变上消化道出血的危险性，亦可作为观察降门脉压力药物疗效的指标．
AIM To study the ultrasonographic prediction of upper digestive tract hemorrhage in patients with portal hypertension. METHODS The diameters of hepatic portal and spleno portal veins were measured by B mode ultrasound in 142 patients with hepatic cirrhosis (without GI tract bleeding, 108; with bleeding, 34) and compared with 75 patients with chronic hepatitis. RESULTS The diameters of hepatic portal and spleno portal veins were related to the prevalence of varices of esophagus and fundus of stomach, and the diameters in the group of patients with cirrhosis accompanying bleeding of upper digestive tract were larger than that in non bleeding group (1 51cm±0 20cm vs 1 19cm±0 23cm, 1 18cm±0 28cm vs 0 94cm±0 18cm, both P <0 01). There was a positive correlation between the diameters of hepatic portal vein, spleno portal vein and bleeding rate ( r =0 99, P <0 01). The diameters of hepao portal vein≥1 5cm and spleno portal vein≥1 1cm were the warning figures for predicting hemorrhage of upper digestive tract. After propranolol treatment in 22 patients with portal hypertension, the diameter of hepao portal and spleno portal vein was decreased. CONCLUSION B mode ultrasonography in measuring the diameter of hepato portal and spleno portal vein can predict bleeding and reflect the therapeutic effect of lowering hypertension of hepao portal vein.
关键词
肝硬变
上消化道出血
超声显像
超声波诊断
Hepatitis\ \ Liver cirrhosis\ \ Hypertention, portal/sonography\ \ Gastrointestinal Hemorrhage/sonography
