什么样的肝硬化病人应该要接受上消化道内镜检查以确保查到食道静脉曲张?

nighthawk

上消化道出血死亡占75%以上肝硬化后期病人的死亡人数. 利用彩色多普勒超声波观察到门静脉流量, 大小还是不能确定食道静脉曲张的度数和病理现象. 只有内镜才是最好的方法, 而且发现不好还可以治疗.



欧洲的一组医生研究结果建议: 凝血时间功能减退70%; 血小板少于十万; 门脉直径大于13毫米的一定要做; 不在这个范围内的可以排除不做;



但是个人认为应该结合其它检查项目, 如, 腹水, 脾机能抗进等综合诊断以防万一, 一旦出血, 后果难料; 该做时, 要做;



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FEBRUARY  2001 LIVER CIRRHOSIS- Which Patients with Cirrhosis should Undergo Endoscopic Screening for Esophageal Varices Detection?



F. Schepis (1),C. Cammà (2),D. Niceforo (1) A. Magnano (3) S. Pallio (1) M. Cinquegrani (1) G. D'Amico (4) Linda Pasta (4) A. Craxì (5) A. Saitta (1) G. Raimondo (1)



(1)Dipartimento di Medicina Interna e Terapia Medica, Policlinico Universitario, Messina; (2)Istituto Metodologie Diagnostiche Avanzate, Consiglio Nazionale delle Ricerche, Palermo; (3)Divisione di Chirurgia Generale, Policlinico Universitario, Messina; (4)Divisione di Medicina, Ospedale V. Cervello, Palermo; (5)Divisione di Medicina Generale e Gastroenterologia, Policlinico Universitario, Palermo.



Our aims were to develop a noninvasive predictive tool to identify cirrhotic patients with esophageal varices and to evaluate whether portal Doppler ultrasonographic parameters may improve the value of other predictors. One hundred forty-three consecutive compensated cirrhotic patients underwent upper gastrointestinal endoscopy. Fourteen clinical, biochemical, ultrasonographic, and Doppler ultrasonographic parameters of each patient were also recorded. Esophageal varices were detected in 63 of the 143 patients examined (44%; 95% confidence interval [CI] 36.2-52.6). Medium and large esophageal varices were observed in 28 subjects (44%; 95% CI 31.4-58.4). Using stepwise logistic regression, presence of esophageal varices was independently predicted by prothrombin activity less than 70% (odds ratio [OR]: 5.83; 95% CI: 2.6-12.8), ultrasonographic portal vein diameter greater than 13 mm (OR: 2.92; 95% CI: 1.3-6.4), and platelet count less than 100 times; 109/L (OR: 2.83; 95% CI: 1.27-6.28). Variables included in the model were used to generate a simple incremental rule to evaluate each individual patient. The discriminating ability of the prediction rule was relevant (area under the curve: 0.80) and did not change by replacing ultrasonographic portal vein diameter with congestion index of portal vein. We concluded that compensated cirrhotic patients should be screened by upper gastrointestinal endoscopy when prothrombin activity less than 70%, platelet count less than 100000, and ultrasonographic portal vein diameter greater than 13 mm are observed, whereas those without any of these predictors should not undergo endoscopy. The contribution provided by portal Doppler ultrasonographic parameters does not appear of practical utility. (Hepatology 33,333-338, 2001)



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