经内镜栓塞术联合套扎术治疗肝硬化食管胃底静脉曲张出血的疗效分析
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摘要
目的研究内镜下食管静脉曲张套扎术(EVL)联合组织胶栓塞术用于肝硬化食管胃底静脉曲张出血(EVB)患者中的疗效及安全性。方法对河南省人民医院2014年1月—2016年6月采用套扎术联合组织胶栓塞术的87例肝硬化食管胃底静脉曲张出血患者的临床资料进行回顾分析,观察疗效及统计并发症。结果早期再出血率3.4%,迟发性再出血率12.8%。术后3月食管静脉曲张显效为37.8%,有效为31.7%;胃底静脉曲张显效为23.2%,有效为29.3%。术后6月食管静脉曲张显效为43.3%,有效为32.1%;胃底静脉曲张显效为26.9%,有效为34.6%。术后并发症有恶心、呕吐55例(63.2%),胸痛43例(49.4%),上腹不适10例(11.5%),发热7例(8%),穿孔1例(1.1%)。结论 EVL联合组织胶栓塞术用于肝硬化食管胃底静脉曲张出血治疗安全有效,但存在一定的并发症。
Objective To explore the therapeutic effects and safety of endoscopic sequential variceal ligation( EVL)combined gastric tissue glue injections for treatment of esophageal and gastric Varices bleeding( EVB) in hepatocirrhosis patients. Methods Totally 87 cases of liver cirrhosis with esophageal gastric varices bleeding were received EVL combined gastric tissue glue injections in Henan Province People 's Hospital during the period from January 2014 to June2016,the effect and complications were observed retrospectively. Results Early re-bleeding was 3. 4% and late re-bleeding was 12. 8%. Esophageal varices narrowed significantly and effctively were 37. 8%,31. 7% and gastric varices narrowed significantly and effctively were 23. 2%,29. 3% three months after the operation. Data were 43. 3%,32. 1%,26. 9%,and 34. 6% respectively six months after the operation. Operation complications,such as nausea,vomiting( 55 cases,62. 3%),sternal pains( 43 cases,49. 4%),epigastric discomfort( 10 cases,11. 5%),fever( 7cases,8%),and perforation( 1cases,1. 1%) were observed. Conclusion The effect of the EVL combined gastric tissue glue injections is a safe and effective procedure for the treatment of gastroesophageal variceal bleeding in hepatocirrhosis patients,but it can bring complications.
Objective To explore the therapeutic effects and safety of endoscopic sequential variceal ligation( EVL)combined gastric tissue glue injections for treatment of esophageal and gastric Varices bleeding( EVB) in hepatocirrhosis patients. Methods Totally 87 cases of liver cirrhosis with esophageal gastric varices bleeding were received EVL combined gastric tissue glue injections in Henan Province People 's Hospital during the period from January 2014 to June2016,the effect and complications were observed retrospectively. Results Early re-bleeding was 3. 4% and late re-bleeding was 12. 8%. Esophageal varices narrowed significantly and effctively were 37. 8%,31. 7% and gastric varices narrowed significantly and effctively were 23. 2%,29. 3% three months after the operation. Data were 43. 3%,32. 1%,26. 9%,and 34. 6% respectively six months after the operation. Operation complications,such as nausea,vomiting( 55 cases,62. 3%),sternal pains( 43 cases,49. 4%),epigastric discomfort( 10 cases,11. 5%),fever( 7cases,8%),and perforation( 1cases,1. 1%) were observed. Conclusion The effect of the EVL combined gastric tissue glue injections is a safe and effective procedure for the treatment of gastroesophageal variceal bleeding in hepatocirrhosis patients,but it can bring complications.
引文
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[5]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.
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[7]程留芳.食管静脉曲张破裂出血内镜下治疗的评价与展望[J].中华消化杂志,2007,27(4):255-256.
[8]陈世耀.内镜治疗食管胃静脉曲张破裂出血的地位[J].实用肝脏病杂志,2013,16(3):198-200.
[9]Garcia-Pagan JC,Barrufet M,Cardenas A,et al.Management of gastric varices[J].Clinical gastroenterology and hepatology:the official clinical practice journal of the American Gastroenterological Association,2014,12(6):919-28 e1;quiz e51-2.
[10]Arakaki Y,Murakami K,Takahashi K,et al.Clinical evaluation of combined endoscopic variceal ligation and sclerotherapy of gastric varices in liver cirrhosis[J].Endoscopy,2003,35(11):940-5.
[11]吴承荣,黄留业,刘运祥,等.经内镜栓塞术联合套扎术治疗食管胃底静脉曲张出血的疗效观察[J].中华消化内镜杂志,2009,26(3):124-127.
[12]Chen WC,Hou MC,Lin HC,et al.Bacteremia after endoscopic injection of N-butyl-2-cyanoacrylate for gastric variceal bleeding[J].Gastrointestinal endoscopy,2001,54(2):214-8.
[2]Bosch J,Garcia-Pagan J C.Prevention of variceal rebleeding[J].Lancet,2003,361(9361):952-4.
[3]Carbonell N,Pauwels A,Serfaty L,et al.Improved survival after variceal bleeding in patients with cirrhosis over the past two decades[J].Hepatology,2004,40(3):652-9.
[4]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].The American journal of gastroenterology,2003,98(9):1982-8.
[5]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.
[6]郑鸾鸾.肝硬化急性静脉曲张出血的治疗现状[J].中华消化杂志,2015,35(2):136-137.
[7]程留芳.食管静脉曲张破裂出血内镜下治疗的评价与展望[J].中华消化杂志,2007,27(4):255-256.
[8]陈世耀.内镜治疗食管胃静脉曲张破裂出血的地位[J].实用肝脏病杂志,2013,16(3):198-200.
[9]Garcia-Pagan JC,Barrufet M,Cardenas A,et al.Management of gastric varices[J].Clinical gastroenterology and hepatology:the official clinical practice journal of the American Gastroenterological Association,2014,12(6):919-28 e1;quiz e51-2.
[10]Arakaki Y,Murakami K,Takahashi K,et al.Clinical evaluation of combined endoscopic variceal ligation and sclerotherapy of gastric varices in liver cirrhosis[J].Endoscopy,2003,35(11):940-5.
[11]吴承荣,黄留业,刘运祥,等.经内镜栓塞术联合套扎术治疗食管胃底静脉曲张出血的疗效观察[J].中华消化内镜杂志,2009,26(3):124-127.
[12]Chen WC,Hou MC,Lin HC,et al.Bacteremia after endoscopic injection of N-butyl-2-cyanoacrylate for gastric variceal bleeding[J].Gastrointestinal endoscopy,2001,54(2):214-8.