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目的:探讨门静脉高压性胃病(portal hypertensive gastropathy,PHG)急性出血的临床诊断,分析PHG的病因、内镜下特点和治疗后转归。方法:收集2013年1月至2016年6月间上海交通大学瑞金医院北院消化内科196例门静脉高压症(门脉高压症)出血的患者,分析其临床资料、内镜检查结果及治疗后转归情况。结果:196例门脉高压出血患者中,内镜诊断为PHG 67例(34.2%),其中轻度PHG 49例(25.0%),重度PHG 18例(9.2%)。经内镜检查证实,5例重度PHG(2.6%)为本次出血的直接原因,13例重度PHG(6.6%)为本次出血的原因之一。所有重度PHG出血患者经血管活性药物及内镜治疗后,急性出血均得到控制。结论:PHG在门脉高压症患者中并不少见,轻度PHG一般不会出血,但应注意其临床演进;重度PHG在内镜下主要表现为广泛樱桃红样出血红斑及弥漫性出血性胃炎,可引起上消化道大量出血,各种降低门静脉压力的治疗方法能有效控制其出血。
Objective: To investigate the clinical diagnosis of acute hypertrophy of portal hypertensive gastropathy (PHG) and analyze the etiology, endoscopic features and prognosis of PHG. Methods: A total of 196 patients with portal hypertension (portal hypertension) hemorrhage were collected from Department of Gastroenterology, North Hospital of Shanghai Ruijin Hospital from January 2013 to June 2016. The clinical data, endoscopic findings and post-treatment changes were collected Return to the situation. Results: Among 196 patients with portal hypertension, endoscopic diagnosis was 67 cases of PHG (34.2%), of which 49 cases were mild PHG (25.0%) and 18 cases were severe PHG (9.2%). Endoscopic examination confirmed that 5 cases of severe PHG (2.6%) is the direct cause of this bleeding, 13 cases of severe PHG (6.6%) is one of the causes of this bleeding. All patients with severe PHG bleeding after vasoactive drugs and endoscopic treatment, acute bleeding are controlled. Conclusion: PHG is not uncommon in patients with portal hypertension, mild PHG generally does not bleed, but should pay attention to its clinical evolution; severe PHG mainly in the endoscopic showed extensive cherry red bleeding erythema and diffuse hemorrhagic gastritis , Can cause a large number of upper gastrointestinal bleeding, a variety of ways to reduce the portal vein pressure can effectively control the bleeding.