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目的 :分析研究不同的食管静脉曲张内镜治疗方法对门静脉高压性胃病(portal hypertensive gastropathy,PHG)的影响。方法 :连续收集2015年1月至2016年3月上海交通大学医学院附属瑞金医院消化科收治的食管静脉曲张内镜治疗患者共35例,给予内镜下硬化剂注射治疗(endoscopic injection sclerotherapy,EIS)或内镜下静脉曲张套扎术(endoscopic varix ligation,EVL),对合并的胃静脉曲张同时给予黏合剂注射栓塞治疗。术后定期随访,随访过程中酌情追加内镜治疗,并评估患者PHG的动态变化。结果:首次接受EIS及EVL的患者分别为17与18例;随访中,上述2组中各有16、13例患者分组不变,其余6例因操作原因、EIS后消退不理想或残余曲张静脉不适合再次行EVL而改用另一种内镜治疗(混合治疗),平均内镜随访时间为(8.6±4.0)个月。内镜治疗前无PHG的患者17例,轻度PHG者为18例,无重度PHG患者;治疗后,无PHG、轻度PHG、重度PHG者分别为16例、16例、3例(P>0.05)。EVL与混合治疗在控制出血和维持PHG稳定方面似优于EIS,治疗前、后患者的平均总体肝功能Child评分分别为(6.77±1.73)分和(6.00±0.91)分,内镜治疗后患者的肝功能明显改善(P<0.01)。结论:食管静脉曲张内镜治疗不会对PHG产生明显负面影响。
Objective: To analyze the effects of different esophageal varices endoscopy on portal hypertensive gastropathy (PHG). Methods: A total of 35 patients with esophageal varices endoscopy treated in Department of Gastroenterology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2015 to March 2016 were enrolled in a consecutive series. Endoscopic injection sclerotherapy (EIS) ) Or endoscopic varix ligation (EVL). The combined gastric varices were treated with adhesive injection and embolization. Regular follow-up after surgery, follow-up process, as appropriate, additional endoscopic treatment, and to assess the dynamic changes in patients with PHG. Results: There were 17 and 18 patients receiving EIS and EVL for the first time. During the follow-up, 16 and 13 patients in each of the two groups remained unchanged, and the remaining 6 patients had subsided after EIS or residual varicose vein due to operation reasons Not suitable for another EVL switch to another endoscopic treatment (mixed treatment), the average endoscopic follow-up time was (8.6 ± 4.0) months. There were 17 cases without PHG before endoscopy, 18 cases with mild PHG, and no severe PHG. After treatment, there were 16 cases, 16 cases and 3 cases of PHG without PHG, 0.05). EVL and mixed therapy were superior to EIS in controlling bleeding and maintaining PHG stability. The mean overall Child function scores (6.77 ± 1.73) and (6.00 ± 0.91) points before and after treatment were significantly lower in patients with endoscopic therapy The liver function was significantly improved (P <0.01). Conclusions: Endoscopic esophageal varices does not have a significant negative effect on PHG.