胃静脉曲张血流动力学分型与临床处理专家共识

doi:10.3877/cma.j.issn.2095-2015.2022.06.002

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

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

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Consensus on hemodynamic classification and clinical management of gastric varices

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Consensus on hemodynamic classification and clinical management of gastric varices