切换至 "中华医学电子期刊资源库"
高级检索
中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2022, Vol. 12 ›› Issue (06) : 325 -333. doi: 10.3877/cma.j.issn.2095-2015.2022.06.002

所属专题： 指南共识；

标准·指南·共识

胃静脉曲张血流动力学分型与临床处理专家共识
中华医学会消化病学分会微创介入协作组   
  • 收稿日期:2022-11-13 出版日期:2022-12-01
  • 基金资助:
    国家自然科学基金(81970533)

Consensus on hemodynamic classification and clinical management of gastric varices

Minimally Invasive Intervention Collaboration Group of the Gastroenterology Branch of the Chinese Medical Association   

  • Received:2022-11-13 Published:2022-12-01
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

中华医学会消化病学分会微创介入协作组. 胃静脉曲张血流动力学分型与临床处理专家共识[J]. 中华消化病与影像杂志(电子版), 2022, 12(06): 325-333.

Minimally Invasive Intervention Collaboration Group of the Gastroenterology Branch of the Chinese Medical Association. Consensus on hemodynamic classification and clinical management of gastric varices[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2022, 12(06): 325-333.

胃静脉曲张(GV)是门静脉高压症并发症之一，虽较食管静脉曲张发生率低，但GV出血不易控制，再出血及死亡率高。GV有着不同于食管静脉曲张的血管解剖和血流动力学特征，因此有着独特与之相对应的临床处理策略。为加深对GV血流动力学分型的认识，制定针对GV出血的个体化诊疗策略，中华医学会消化病学分会微创介入协作组邀请该领域部分专家制定本共识。

关键词: 门静脉高压, 胃静脉曲张, 血流动力学, 临床处理

Gastric varices(GV), as one of the complications of portal hypertension, has a lower incidence than esophageal varices, but bleeding from GV is not easy to control and associated with a high rebleeding rate and high mortality.GV has different characteristics of vascular anatomy and hemodynamics from esophageal varices, with a unique corresponding clinical management strategy.In order to deepen the understanding of GV hemodynamic characteristics and formulate an individualized treatment strategy for GV bleeding, the Minimally Invasive Intervention Collaboration Group of the Gastroenterology Branch of the Chinese Medical Association invites some experts in this field to formulate this consensus.

Key words: Portal hypertension, Gastric varices, Hemodynamics, Clinical treatment
表1 推荐意见的证据等级和推荐强度等级[2]
证据质量  
高(A) 进一步研究不可能改变对该疗效评估结果的可信度
中(B) 进一步研究有可能影响该疗效评估结果的可信度，且可能改变该评估结果
低或非常低(C) 进一步研究很有可能影响该疗效评估结果的可信度，且很可能改变该评估结果
推荐强度等级  
强(1) 明确显示干预措施利大于弊或弊大于利
弱(2) 利弊不确定或无论质量高低的证据均显示利弊相当
图1 胃静脉曲张及血流动力学特征注：根据文献[3]修改。EV，食管静脉曲张；GV，胃静脉曲张；GRS，胃肾分流道；GCS，胃腔分流道；IPV，膈下静脉；IVC，下腔静脉；LGV，胃左静脉；LRV，左肾静脉；PCPV，心包膈静脉；PGV，胃后静脉；PV，门静脉；SGV，胃短静脉；SMV，肠系膜上静脉；SV，脾静脉
图2 胃静脉曲张Saad-Caldwell分型注：根据文献[11]修改。EV，食管静脉曲张；GV，胃静脉曲张；GRS，胃肾分流道；IVC，下腔静脉；LGV，胃左静脉；LRV，左肾静脉；PV，门静脉；SGV，胃短静脉；PGV，胃后静脉；SMV，肠系膜上静脉；SV，脾静脉
图3 胃静脉曲张Kiyosue分型注：根据文献[11]修改。EV，食管静脉曲张；GCS，胃腔分流道；GRS，胃肾分流道；GV，胃静脉曲张；IPV，膈下静脉；IVC，下腔静脉；LGV，胃左静脉；LRV，左肾静脉；PGV，胃后静脉；PV，门静脉；SGV，胃短静脉；SMV，肠系膜上静脉；SV，脾静脉
图4 传统BRTO及改良BRTO示意图注：A为传统BRTO，金属圈栓塞胃腔分流后，球囊导管阻断胃肾分流，注射硬化剂逆行硬化GV；B为PARTO，金属圈栓塞胃腔分流后(如合并)，血管塞阻断胃肾分流，经导管逆行注射明胶海绵浆栓塞GV；C为CARTO，金属圈栓塞胃腔分流后(如合并)，金属圈阻断胃肾分流，经导管逆行注射明胶海绵浆栓塞GV。GCS，胃腔分流道；GRS，胃肾分流道；GV，胃静脉曲张；IVC，下腔静脉；LRV，左肾静脉；PV，门静脉；BRTO，球囊阻断逆行曲张静脉闭塞术；PARTO，血管塞辅助逆行曲张血管栓塞术；CARTO，金属圈辅助逆行曲张血管栓塞术
图5 胃静脉曲张治疗流程图[8]注：CTP，Child-Turcotte-Pugh；GOV1，胃食管静脉曲张1型；GOV2，胃食管静脉曲张2型；IGV，孤立性胃静脉曲张；TIPS，经颈静脉肝内门体分流术；BRTO，球囊阻断逆行曲张静脉闭塞术
1
Henry Z，Patel K，Patton H，et al.AGA Clinical Practice Update on Management of Bleeding Gastric Varices: Expert Review[J]．Clin Gastroenterol Hepatol，2021，19(6): 1098-1107.e1.
2
Atkins D，Best D，Briss PA，et al.Grading quality of evidence and strength of recommendations[J]．BMJ，2004，328(7454): 1490.
3
Philips CA，Ahamed R，Rajesh S，et al.Beyond the scope and the glue: update on evaluation and management of gastric varices[J]．BMC Gastroenterol，2020，20(1): 361.
4
Luo X，Hernandez-Gea V．Update on the management of gastric varices[J]．Liver Int，2022，42(6): 1250-1258.
5
Saad WE.Vascular anatomy and the morphologic and hemodynamic classifications of gastric varices and spontaneous portosystemic shunts relevant to the BRTO procedure[J]．Tech Vasc Interv Radiol，2013，16(2): 60-100.
6
Chao Y，Lin HC，Lee FY，et al.Hepatic hemodynamic features in patients with esophageal or gastric varices[J]．J Hhepatol，1993，19(1): 85-89.
7
中华医学会肝病学分会，中华医学会消化病学分会，中华医学会内镜学分会．肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]．临床肝胆病杂志，2016，32(2): 203-219.
8
李志群，令狐恩强，刘迎娣，等．LDRf分型在食管联合胃底静脉曲张初次内镜治疗中的应用价值[J]．中华消化内镜杂志，2015，32(6): 388-390.
9
Henry Z．Treatment of Gastro-Fundal Varices(Including a Discussion of BRTO)[J]．Current Hepatology Reports，2018，17(3): 184-192.
10
中华医学会消化内镜学分会食管胃静脉曲张学组．消化道静脉曲张及出血的内镜诊断和治疗规范试行方案(2009年)[J]．中华消化内镜杂志，2010，27(1): 1-4.
11
Kiyosue H，Mori H，Matsumoto S，et al.Transcatheter obliteration of gastric varices.Part 1.Anatomic classification[J]．Radiographics，2003，23(4): 911-920.
12
Kouanda A，Binmoeller K，Hamerski C，et al.Safety and efficacy of EUS-guided coil and glue injection for the primary prophylaxis of gastric variceal hemorrhage[J]．Gastrointest Endosc，2021，94(2): 291-296.
13
Mishra SR，Sharma BC，Kumar A，et al.Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: a randomized controlled trial[J]．J Hepatol，2011，54(6): 1161-1167.
14
Villanueva C，Albillos A，Genesca J，et al.beta blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension(PREDESCI): a randomised，double-blind，placebo-controlled，multicentre trial[J]．Lancet，2019，393(10181): 1597-1608.
15
Gralnek IM，Camus Duboc M，Garcia-Pagan JC，et al.Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy(ESGE) Guideline[J]．Endoscopy，2022，54(11): 1094-1120.
16
Villanueva C，Torres F，Sarin SK，et al.Carvedilol reduces the risk of decompensation and mortality in patients with compensated cirrhosis in a competing-risk meta-analysis[J]．J Hepatol，2022，77(4): 1014-1025.
17
Kimer N，Hobolth L．Editorial: timing of carvedilol - promoting survivors in cirrhosis[J]．Aliment Pharmacol Ther，2022，56(1): 172-173.
18
Bhat YM，Weilert F，Fredrick RT，et al.EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U．S.experience over 6 years(with video)[J]．Gastrointest Endosc，2016，83(6): 1164-1172.
19
Choe JW，Yim HJ，Lee SH，et al.Primary prophylaxis of gastric variceal bleeding: endoscopic obturation，radiologic intervention，or observation？[J]．Hepatol Int，2021，15(4): 934-945.
20
de Franchis R，Bosch J，Garcia-Tsao G，et al.Baveno VII - Renewing consensus in portal hypertension[J]．J Hepatol，2022，76(4): 959-974.
21
Garcia-Tsao G，Abraldes JG，Berzigotti A，et al.Portal hypertensive bleeding in cirrhosis: Risk stratification，diagnosis，and management: 2016 practice guidance by the American Association for the study of liver diseases[J]．Hepatology，2017，65(1): 310-335.
22
European Association for the Study of the Liver.Electronic address eee，European Association for the Study of the L．EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis[J]．J Hepatol，2018，69(2): 406-460.
23
Villanueva C，Albillos A，Genescà J，et al.β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension(PREDESCI): a randomised，double-blind，placebo-controlled，multicentre trial[J]．Lancet，2019，393(10181): 1597-1608.
24
Maydeo A，Patil G．How to Approach a Patient With Gastric Varices[J]．Gastroenterology，2022，162(3): 689-695.
25
Tripathi D，Stanley AJ，Hayes PC，et al.U.K.guidelines on the management of variceal haemorrhage in cirrhotic patients[J]．Gut，2015，64(11): 1680-1704.
26
de Franchis R．Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension[J]．J Hepatol，2015，63(3): 743-752.
27
Caldwell SH，Hespenheide EE，Greenwald BD，et al.Enbucrilate for gastric varices: extended experience in 92 patients[J]．Aliment Pharmacol Ther，2007，26(1): 49-59.
28
Greenwald BD，Caldwell SH，Hespenheide EE，et al.N-2-butyl-cyanoacrylate for bleeding gastric varices: a United States pilot study and cost analysis[J]．Am J Gastroenterol，2003，98(9): 1982-1988.
29
Lo GH，Lai KH，Cheng JS，et al.A prospective，randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices[J]．Hepatology，2001，33(5): 1060-1064.
30
Cheng LF，Wang ZQ，Li CZ，et al.Low incidence of complications from endoscopic gastric variceal obturation with butyl cyanoacrylate[J]．Clin Gastroenterol Hepatol，2010，8(9): 760-766.
31
Guo YW，Miao HB，Wen ZF，et al.Procedure-related complications in gastric variceal obturation with tissue glue[J]．World J Gastroenterol，2017，23(43): 7746-7755.
32
Romero-Castro R，Ellrichmann M，Ortiz-Moyano C，et al.EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study(with videos)[J]．Gastrointest Endosc，2013，78(5): 711-721.
33
Panés J，Terés J，Bosch J，et al.Efficacy of balloon tamponade in treatment of bleeding gastric and esophageal varices.Results in 151 consecutive episodes[J]．Dig Dis Sci，1988，33(4): 454-459.
34
Azoulay D，Castaing D，Majno P，et al.Salvage transjugular intrahepatic portosystemic shunt for uncontrolled variceal bleeding in patients with decompensated cirrhosis[J]．J Hepatol，2001，35(5): 590-597.
35
Chau TN，Patch D，Chan YW，et al. "Salvage" transjugular intrahepatic portosystemic shunts: gastric fundal compared with esophageal variceal bleeding[J]．Gastroenterology，1998，114(5): 981-987.
36
Barange K，Péron JM，Imani K，et al.Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices[J]．Hepatology(Baltimore，Md)，1999，30(5): 1139-1143.
37
Zhu Y，Wang X，Xi X，et al.Emergency Transjugular Intrahepatic Portosystemic Shunt: an Effective and Safe Treatment for Uncontrolled Variceal Bleeding[J]．J Gastrointest Surg，2019，23(11): 2193-2200.
38
Krajina A，Hulek P，Fejfar T，et al.Quality improvement guidelines for Transjugular Intrahepatic Portosystemic Shunt(TIPS)[J]．Cardiovasc Intervent Radiol，2012，35(6): 1295-1300.
39
Hong CH，Kim HJ，Park JH，et al.Treatment of patients with gastric variceal hemorrhage: endoscopic N-butyl-2-cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration[J]．J Gastroenterol Hepatol，2009，24(3): 372-378.
40
Lee EW，Shahrouki P，Alanis L，et al.Management Options for Gastric Variceal Hemorrhage[J]．JAMA Surg，2019，154(6): 540-548.
41
Hung HH，Chang CJ，Hou MC，et al.Efficacy of non-selective beta-blockers as adjunct to endoscopic prophylactic treatment for gastric variceal bleeding: a randomized controlled trial[J]．J Hepatol，2012，56(5): 1025-1032.
42
Chen WC，Hsin IF，Chen PH，et al.Addition of Carvedilol to Gastric Variceal Obturation Does Not Decrease Recurrence of Gastric Variceal Bleeding in Patients With Cirrhosis[J]．Clin Gastroenterol Hepatol，2019，17(11): 2356-2363.e2.
43
McCarty TR，Bazarbashi AN，Hathorn KE，et al.Combination therapy versus monotherapy for EUS-guided management of gastric varices: A systematic review and meta-analysis[J]．Endosc Ultrasound，2020，9(1): 6-15.
44
Sarin SK，Kumar A．Endoscopic treatment of gastric varices[J]．Clin Liver Dis，2014，18(4): 809-827.
45
Mishra SR，Chander Sharma B，Kumar A，et al.Endoscopic cyanoacrylate injection versus beta-blocker for secondary prophylaxis of gastric variceal bleed: a randomised controlled trial[J]．Gut，2010，59(6): 729-735.
46
Soehendra N，Nam VC，Grimm H，et al.Endoscopic obliteration of large esophagogastric varices with bucrylate[J]．Endoscopy，1986，18(1): 25-26.
47
Rengstorff DS，Binmoeller KF.A pilot study of 2-octyl cyanoacrylate injection for treatment of gastric fundal varices in humans[J]．Gastrointest Endosc，2004，59(4): 553-558.
48
Weilert F，Binmoeller KF.Endoscopic management of gastric variceal bleeding[J]．Gastroenterol Clin North Am，2014，43(4): 807-818.
49
Wang G，Zhang C，Shi Y．Cerebral Embolism due to Portopulmonary Venous Anastomosis During Endoscopic Therapy for Gastric Varices[J]．Am J Gastroenterol，2019，114(12): 1833.
50
Seewald S，Ang TL，Imazu H，et al.A standardized injection technique and regimen ensures success and safety of N-butyl-2-cyanoacrylate injection for the treatment of gastric fundal varices(with videos)[J]．Gastrointest Endosc，2008，68(3): 447-454.
51
Ryan BM，Stockbrugger RW，Ryan JM.A pathophysiologic，gastroenterologic，and radiologic approach to the management of gastric varices[J]．Gastroenterology，2004，126(4): 1175-1189.
52
Hou MC，Lin HC，Lee HS，et al.A randomized trial of endoscopic cyanoacrylate injection for acute gastric variceal bleeding: 0.5 mL versus 1.0 mL[J]．Gastrointest Endosc，2009，70(4): 668-675.
53
van Beek AP，van Erpecum KJ.Fatal N-butyl-2-cyanoacrylate pulmonary embolism after sclerotherapy for variceal bleeding[J]．Endoscopy，2005，37(7): 687.
54
Cheng LF，Wang ZQ，Li CZ，et al.Treatment of gastric varices by endoscopic sclerotherapy using butyl cyanoacrylate: 10 years′ experience of 635 cases[J]．Chin Med J，2007，120(23): 2081-2085.
55
Romero-Castro R，Pellicer-Bautista FJ，Jimenez-Saenz M，et al.EUS-guided injection of cyanoacrylate in perforating feeding veins in gastric varices: results in 5 cases[J]．Gastrointest Endosc，2007，66(2): 402-407.
56
Bick BL，Al-Haddad M，Liangpunsakul S，et al.EUS-guided fine needle injection is superior to direct endoscopic injection of 2-octyl cyanoacrylate for the treatment of gastric variceal bleeding[J]．Surg Endosc，2019，33(6): 1837-1845.
57
Binmoeller KF，Weilert F，Shah JN，et al.EUS-guided transesophageal treatment of gastric fundal varices with combined coiling and cyanoacrylate glue injection(with videos)[J]．Gastrointest Endosc，2011，74(5): 1019-1025.
58
Li H，Ye D，Kong D．Endoscopic clipping prior to n-butyl-2-cyanoacrylate injection for gastric varices with a large gastrorenal shunt[J]．Endoscopy，2018，50(4): E102-E103.
59
Zhang M，Li P，Mou H，et al.Clip-assisted endoscopic cyanoacrylate injection for gastric varices with a gastrorenal shunt: a multicenter study[J]．Endoscopy，2019，51(10): 936-940.
60
Lo GH，Liang HL，Chen WC，et al.A prospective，randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding[J]．Endoscopy，2007，39(8): 679-685.
61
Procaccini NJ，Al-Osaimi AM，Northup P，et al.Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U．S.analysis[J]．Gastrointest Endosc，2009，70(5): 881-887.
62
Boike JR，Thornburg BG，Asrani SK，et al.North American Practice-Based Recommendations for Transjugular Intrahepatic Portosystemic Shunts in Portal Hypertension[J]．Clin Gastroenterol Hepatol，2022，20(8): 1636-1662.e36.
63
中国医师协会介入医师分会．中国门静脉高压经颈静脉肝内门体分流术临床实践指南[J]．中华肝脏病杂志，2019，27(8): 582-593.
64
Fagiuoli S，Bruno R，Debernardi Venon W，et al.Consensus conference on TIPS management: Techniques，indications，contraindications[J]．Dig Liver Dis，2017，49(2): 121-137.
65
Chen S，Li X，Wei B，et al.Recurrent variceal bleeding and shunt patency: prospective randomized controlled trial of transjugular intrahepatic portosystemic shunt alone or combined with coronary vein embolization[J]．Radiology，2013，268(3): 900-906.
66
Yu J，Wang X，Jiang M，et al.Comparison of transjugular intrahepatic portosystemic shunt(TIPS) alone and combined with embolisation for the management of cardiofundal varices: a retrospective study[J]．Eur Radiol，2019，29(2): 699-706.
67
Park JK，Saab S，Kee ST，et al.Balloon-Occluded Retrograde Transvenous Obliteration(BRTO) for Treatment of Gastric Varices: Review and Meta-Analysis[J]．Dig Dis Sci，2015，60(6): 1543-1553.
68
Akahoshi T，Tomikawa M，Kamori M，et al.Impact of balloon-occluded retrograde transvenous obliteration on management of isolated fundal gastric variceal bleeding[J]．Hepatol Res，2012，42(4): 385-393.
69
Emori K，Toyonaga A，Oho K，et al.Balloon-occluded retrograde transvenous obliteration versus endoscopic injection sclerotherapy for isolated gastric varices: a comparative study[J]．Kurume Med J，2014，60(3/4): 105-113.
70
Stein DJ，Salinas C，Sabri S，et al.Balloon Retrograde Transvenous Obliteration Versus Endoscopic Cyanoacrylate in Bleeding Gastric Varices: Comparison of Rebleeding and Mortality with Extended Follow-up[J]．J Vasc Interv Radiol，2019，30(2): 187-194.
71
Gimm G，Chang Y，Kim HC，et al.Balloon-Occluded Retrograde Transvenous Obliteration versus Transjugular Intrahepatic Portosystemic Shunt for the Management of Gastric Variceal Bleeding[J]．Gut Liver，2018，12(6): 704-713.
72
Luo X，Xiang T，Wu J，et al.Endoscopic Cyanoacrylate Injection Versus Balloon-Occluded Retrograde Transvenous Obliteration for Prevention of Gastric Variceal Bleeding: A Randomized Controlled Trial[J]．Hepatology，2021，74(4): 2074-2084.
73
Yu Q，Liu C，Raissi D．Balloon-occluded Retrograde Transvenous Obliteration Versus Transjugular Intrahepatic Portosystemic Shunt for Gastric Varices: A Meta-Analysis[J]．J Clin Gastroenterol，2021，55(2): 147-158.
74
Mukund A，Rana S，Mohan C，et al.Indian College of Radiology and Imaging Evidence-Based Guidelines for Interventions in Portal Hypertension and Its Complications[J]．Indian J Radiol Imaging，2021，31(4): 917-932.
75
Tanihata H，Minamiguchi H，Sato M，et al.Changes in portal systemic pressure gradient after balloon-occluded retrograde transvenous obliteration of gastric varices and aggravation of esophageal varices[J]．Cardiovasc Intervent Radiol，2009，32(6): 1209-1216.
76
Saad WE.Balloon-occluded retrograde transvenous obliteration of gastric varices: concept，basic techniques，and outcomes[J]．Semin Intervent Radiol，2012，29(2): 118-128.
[1] 魏淑婕, 惠品晶, 丁亚芳, 张白, 颜燕红, 周鹏, 黄亚波. 单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥术的脑血流动力学评估[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1046-1055.
[2] 李凤仪, 李若凡, 高旭, 张超凡. 目标导向液体干预对老年胃肠道肿瘤患者术后血流动力学、胃肠功能恢复的影响[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 29-32.
[3] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[4] 吴丽娜, 魏林, 曾志贵, 张梁, 何恩辉, 檀玉乐, 朱志军, 孙丽莹. 肺动脉高压靶向药物联合肝移植治疗重度门脉性肺动脉高压一例[J]. 中华移植杂志(电子版), 2022, 16(06): 376-378.
[5] 李祥魁, 薛玉荣, 丁凯, 孔劲松. ESPB、SAPB、TPVB对胸腔镜微创术血流动力学、应激反应的影响[J]. 中华肺部疾病杂志(电子版), 2023, 16(02): 245-247.
[6] 王英, 薛意恒, 刘国勤. 肠系膜下动脉-高位结扎后降乙结肠血流通路重建机制研究方法的探索历程[J]. 中华结直肠疾病电子杂志, 2023, 12(04): 265-271.
[7] 王姗姗, 徐小汝, 史振仙, 张德杰. 丹参多酚酸联合尤瑞克林治疗急性分水岭脑梗死的疗效及对认知功能、脑血流动力学和血清LPA、ox-LDL、MMP-9水平的影响[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(03): 142-149.
[8] 秦维, 王丹, 孙玉, 霍玉玲, 祝素平, 郑艳丽, 薛瑞. 血清层粘连蛋白、Ⅳ型胶原蛋白对代偿期肝硬化食管胃静脉曲张出血的预测价值[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 447-451.
[9] 李田利, 张照龙, 孙成建, 刘国平, 谢宜兴, 赵晓龙, 邵黎明, 郑璇, 王长鑫, 徐锐. 基于血流动力学、血脂及外周血炎症标志物的眼段动脉瘤破裂风险相关研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(02): 78-83.
[10] 朱风尚, 舍玲, 丁永年, 杨长青. 五步疑问法在肝硬化门静脉高压症临床教学中的应用[J]. 中华消化病与影像杂志(电子版), 2023, 13(02): 116-118.
[11] 陈晓琴, 李星江, 胡涛, 赵金义, 薛培源, 刘伟, 王崇, 胡明成. 椎基底动脉迂曲扩张症的计算流体力学分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(01): 21-25.
[12] 梁晓宁, 吕朝阳, 郭瑞君. 床旁超声在同期胰肾联合移植治疗I型糖尿病术后的检查思路与探讨[J]. 中华临床医师杂志(电子版), 2022, 16(06): 553-557.
[13] 林加文, 印于, 杨俊, 朱晓黎, 王万胜. 肝动门静脉瘘合并腹水一例[J]. 中华介入放射学电子杂志, 2023, 11(03): 289-291.
[14] 王彦旭, 何益港, 秦永林. 计算流体力学研究B型主动脉夹层中4D Flow MRI的应用进展[J]. 中华介入放射学电子杂志, 2023, 11(02): 159-163.
[15] 张晓彬, 刘迎娣, 王娟, 孙国辉, 钟立森, 何占娣, 令狐恩强. 孤立性胃静脉曲张临床诊疗经验[J]. 中华胃肠内镜电子杂志, 2023, 10(03): 167-172.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号