目的探讨肝硬化合并食管胃底静脉曲张2型（gastroesophageal varices type 2，GOV2）与孤立性胃静脉曲张1型（isolated gastric varices type 1，IGV1）患者在临床特征、影像学表现的差异。
方法回顾性纳入2013年10月—2021年3月华中科技大学同济医学院附属协和医院收治的肝硬化合并胃底静脉曲张患者，收集并分析其临床及影像学资料。
结果共纳入患者210例，其中139例GOV2型，71例IGV1型。血常规结果显示患者中位血红蛋白降低，其中GOV2组较IGV1组更显著（91.00 g/L比112.00 g/L， P<0.05），GOV2组较IGV1组肝硬化门静脉高压性胃病发生率高［20.14%（28/139）比5.63%（4/71）， P<0.05］；而消化性溃疡发生率低［12.23%（17/139）比38.03%（27/71）， P<0.05］。GOV2组门静脉主干中位直径大于IGV1组（15.09 mm比12.85 mm， P<0.05），胃底曲张静脉中位体积显著小于IGV1组（2.14 mL比10.00 mL， P<0.05）。GOV2组流入血管胃左静脉的构成比例高于IGV1组［98.43%（125/127）比77.78%（42/54）， P<0.05］且胃左静脉中位直径较IGV1组更大（5.58 mm比4.53 mm， P<0.05）；流出血管主要包括胃肾分流、脾肾分流，GOV2组与IGV1组相比，胃肾分流发生率［27.56%（35/127）比66.67%（36/54）， P<0.05］与脾肾分流发生率［12.60%（16/127）比25.93%（14/54）， P<0.05］均较低，而附脐静脉开放［38.58%（49/127）比12.96%（7/54）， P<0.05］与腹膜后侧枝分流［30.71%（39/127）比11.11%（6/54）， P<0.05］相对多见。
结论肝硬化合并GOV2型与IGV1型患者在临床特征和影像学表现方面存在显著异质性。充分认识和理解两型患者间差异，可为临床采取适宜的治疗措施提供依据，有益于改善患者预后。
ObjectiveTo investigate the differences in clinical features and imaging findings of cirrhotic patients with fundic varices between gastroesophageal varices type 2 (GOV2) and isolated fundic varices type 1 (IGV1).
MethodsClinical and imaging data of cirrhotic patients with fundic varices treated in Union Hospital, Tonji Medical Colloge, of Huazhong University of Science and Technology from October 2013 to March 2021 were retrospectively analyzed.
ResultsA total of 210 patients were enrolled, including 139 patients of GOV2 (GOV2 group) and 71 patients of IGV1 (IGV1 group). Blood routine examination results showed that the median value of hemoglobin in GOV2 group was lower than that in IGV1 group(91.00 g/L VS 112.00 g/L, P<0.05). The incidence of portal hypertensive gastropathy (PHG) in GOV2 group was higher than that in IGV1 group [20.14% (28/139) VS 5.63% (4/71), P<0.05]. The incidence of peptic ulcer was lower in GOV2 group than that in IGV1 group [12.23% (17/139) VS 38.03% (27/71), P<0.05]. The median diameter of portal veins in GOV2 group was larger than that in IGV1 group (15.09 mm VS 12.85 mm, P<0.05), and the volume of gastric fundus varices in GOV2 group was smaller than that in IGV1 group (2.14 mL VS 10.00 mL, P<0.05). The proportion of afferent veins in left gastric vein in GOV2 group was higher than that in IGV1 group [98.43% (125/127) VS 77.78% (42/54), P<0.05], and the median diameter of left gastric vein in GOV2 group was larger than that in IGV1 group (5.58 mm VS 4.53 mm, P<0.05). The efferent vessels mainly included gastrorenal shunt and splenorenal shunt. The incidences of gastrorenal shunt [27.56% (35/127) VS 66.67% (36/54)] and splenirenal shunt [12.60% (16/127) VS 25.93% (14/54)] in GOV2 group were lower than those in IGV1 group ( both P<0.05). The incidences of venae parumbilicales vein [38.58% (49/127) VS 12.96% (7/54)] and retroperitoneal collateral shunt [30.71% (39/127) VS 11.11% (6/54)] in GOV2 group were higher than those in IGV1 group (both P<0.05).
ConclusionThere is significant heterogeneity in clinical features and imaging findings between cirrhotic patients complicated with GOV2 and IGV1. Recognizing and understanding the differences between the two types of patients is beneficial to taking appropriate clinical measures and improving patient prognosis.
司可可,向红雨,王泽慧,等. 肝硬化食管胃底静脉曲张2型与孤立性胃静脉曲张1型的临床和影像学差异[J]. 中华消化内镜杂志,2022,39(09)：725-730.
DOI:10.3760/cma.j.cn321463-20211018-00502版权归中华医学会所有。
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司可可：数据采集与分析、论文撰写；向红雨：数据分析；王泽慧：数据采集；宋宇虎：研究设计、论文审阅；李欣：数据分析与解释、技术支持、论文审阅
司可可, 向红雨, 王泽慧, 等. 肝硬化食管胃底静脉曲张2型与孤立性胃静脉曲张1型的临床和影像学差异[J]. 中华消化内镜杂志, 2022, 39(9): 725-730. DOI: 10.3760/cma.j.cn321463-20211018-00502.
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