无碘油稀释氰基丙烯酸酯在预防性治疗胃静脉曲张中的应用
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摘要
目的评价无碘油稀释氰基丙烯酸酯(NBCM)在内镜预防治疗胃静脉曲张的有效性与安全性。方法收集2012年1月-2012年10月该院20例门静脉高压症胃静脉曲张(GV)患者伴或不伴食管静脉曲张(EV),釆用无碘油组织粘合剂NBCM治疗处理。采用生理盐水、α-氰基丙烯酸酯和生理盐水夹心法治疗。内镜证实出血停止,治疗0.5 d后患者无呕血及便血等现象,生命体征平稳。记录患者术中、术后并发症。所有患者术后接受随访,记录出血复发及其他不良事件。结果 20例门静脉高压伴胃底静脉曲张患者接受NBCM内镜预防性治疗。18例(90%)患者曾采用内镜套扎(EBL)术治疗EV,其余患者无EV。13例(65%)患者在第1疗程(1期)治疗中GV闭塞,7例(35%)患者在第2疗程(2期)治疗中GV闭塞,平均NBVM用量为(1.37±0.48)ml。6个月随访中,仅1例(5%)患者GV复发,1例患者在第35个月随访中经内镜超声确认GV复发。总体而言,在6~40个月,中数31个月的随访中,GV复发率为10%,出血率为5%。该组病例未发现死亡案例,3例患者(15%)报告存在轻度胃痛,其与患者未发现严重不良事件(全身性栓塞、败血症或胃肠道出血)。结论无碘油NBCM内镜注射是胃静脉曲张性出血的一种安全有效的初始预防性治疗方式。
【Objective】 To evaluate the efficacy and safety of undiluted N-butyl-2 cyanoacrylate plus methacryloxysulfolane(NBCM) as a prophylactic treatment for gastric varices(GV) bleeding. 【Methods】 This prospective study was conducted at this hospital between January 2010 and October 2010. Patients with portal hypertension(PH) and GV, with no active gastrointestinal bleeding, were enrolled in primary prophylactic treatment with NBCM injection without lipiodol dilution. Initial diagnosis of GV was based on endoscopy and confirmed with endosonography(EUS); the same procedure was used after treatment to confirm eradication of GV. Patients were followed up clinically and evaluated with endoscopy at 3, 6 and 12 mo. Later follow-ups were performed yearly. The main outcome measures were efficacy(GV eradication), safety(adverse events related to cyanoacrylate injection), recurrence, bleeding from GV and mortality related to GV treatment. 【Results】A total of 20 patients(15 male) with PH and GV were enrolled in the study and treated with undiluted NBCM injection. Only 2(10%) patients had no esophageal varices(EV); 18(90%) patients were treated with endoscopic band ligation to eradicate EV before inclusion in the study. The patients were followed up clinically and endoscopically for a median of 31 mo(range: 6 ~40mo). Eradication of GV was observed in all patients(13 patients were treated with 1 session and 7 patients with 2sessions), with a maximum injected volume of 2 ml NBCM. One patient had GV recurrence, confirmed by EUS, at 6-mo follow-up, and another had late recurrence with GV bleeding after 35 mo of followup; overall, GV recurrence was observed in 2 patients(10%), after 6 and 35 mo of follow-up, and GV bleeding rate was 5%(1 patient). Mild epigastric pain was reported by 3 patients(15%). No mortality or major complications, including embolism, or damage to equipment were observed. 【Conclusion】Endoscopic injection with NBCM, without lipiodol, may be a safe and effective treatment of primary prophylaxis for gastric variceal bleeding.
【Objective】 To evaluate the efficacy and safety of undiluted N-butyl-2 cyanoacrylate plus methacryloxysulfolane(NBCM) as a prophylactic treatment for gastric varices(GV) bleeding. 【Methods】 This prospective study was conducted at this hospital between January 2010 and October 2010. Patients with portal hypertension(PH) and GV, with no active gastrointestinal bleeding, were enrolled in primary prophylactic treatment with NBCM injection without lipiodol dilution. Initial diagnosis of GV was based on endoscopy and confirmed with endosonography(EUS); the same procedure was used after treatment to confirm eradication of GV. Patients were followed up clinically and evaluated with endoscopy at 3, 6 and 12 mo. Later follow-ups were performed yearly. The main outcome measures were efficacy(GV eradication), safety(adverse events related to cyanoacrylate injection), recurrence, bleeding from GV and mortality related to GV treatment. 【Results】A total of 20 patients(15 male) with PH and GV were enrolled in the study and treated with undiluted NBCM injection. Only 2(10%) patients had no esophageal varices(EV); 18(90%) patients were treated with endoscopic band ligation to eradicate EV before inclusion in the study. The patients were followed up clinically and endoscopically for a median of 31 mo(range: 6 ~40mo). Eradication of GV was observed in all patients(13 patients were treated with 1 session and 7 patients with 2sessions), with a maximum injected volume of 2 ml NBCM. One patient had GV recurrence, confirmed by EUS, at 6-mo follow-up, and another had late recurrence with GV bleeding after 35 mo of followup; overall, GV recurrence was observed in 2 patients(10%), after 6 and 35 mo of follow-up, and GV bleeding rate was 5%(1 patient). Mild epigastric pain was reported by 3 patients(15%). No mortality or major complications, including embolism, or damage to equipment were observed. 【Conclusion】Endoscopic injection with NBCM, without lipiodol, may be a safe and effective treatment of primary prophylaxis for gastric variceal bleeding.
引文
[1]陈世耀,陈洁.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.
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[4]熊小强,胡旭民,凌小婷,等.内镜下氰基丙烯酸酯注射法与套扎法治疗胃底食管静脉曲张的Meta分析[J].中华普通外科学文献:电子版,2012,6(2):49-54.
[5]KURT M,AKDOGAN M,SAYILIR A,et al.Effect of endoscopic injection therapy with combined cyanoacrylate and lipiodol for bleeding gastric varices:a single center experience[J].Journal of Digestive Diseases,2010,11(5):284-290.
[6]ZHANG CQ,LIU FL,LIANG B,et al.A modified percutaneous transhepatic variceal embolization with 2-octyl cyanoacrylate versus endoscopic ligation in esophageal variceal bleeding management:randomized controlled trial[J].Digestive Diseases and Sciences,2008,53(8):2258-2267.
[7]DHIMAN RK,CHAWLA Y,TANEJA S,et al.Endoscopic sclerotherapy of gastric variceal bleeding with N-butyl-2-cyanoacrylate[J].J Clin Gastroenterol,2002,35(9):222-227.
[8]KUMAR A,SINGH S,MADAN K,et al.Undiluted N-butyl cyanoacrylate is safe and effective for gastric variceal bleeding[J].Gastrointest Endosc,2010,72(9):721-727.
[9]SARACCO G,GIORDANINO C,ROBERTO N,et al.Fatal multiple systemic embolisms after injection of cyanoacrylate in bleeding gastric varices of a patient who was noncirrhotic but with idiopathic portal hypertension[J].Gastrointest Endosc,2007,65(11):345-347.
[2]TULSYAN N,KASHYAP VS,GREENBERG RK,et al.The endovascular management of visceral artery aneurysms and pseudoaneurysms[J].Journal of Vascular Surgery,2007,45(2):276-283.
[3]CORSO AD,BARGELLINI I,CICORELLI A,et al.Efficacy and safety of a novel vascular closure device(glubran 2 seal)after diagnostic and interventional angiography in patients with peripheral arterial occlusive disease[J].Cardio Vascular and Interventional Radiology,2013,36(2):371-376.
[4]熊小强,胡旭民,凌小婷,等.内镜下氰基丙烯酸酯注射法与套扎法治疗胃底食管静脉曲张的Meta分析[J].中华普通外科学文献:电子版,2012,6(2):49-54.
[5]KURT M,AKDOGAN M,SAYILIR A,et al.Effect of endoscopic injection therapy with combined cyanoacrylate and lipiodol for bleeding gastric varices:a single center experience[J].Journal of Digestive Diseases,2010,11(5):284-290.
[6]ZHANG CQ,LIU FL,LIANG B,et al.A modified percutaneous transhepatic variceal embolization with 2-octyl cyanoacrylate versus endoscopic ligation in esophageal variceal bleeding management:randomized controlled trial[J].Digestive Diseases and Sciences,2008,53(8):2258-2267.
[7]DHIMAN RK,CHAWLA Y,TANEJA S,et al.Endoscopic sclerotherapy of gastric variceal bleeding with N-butyl-2-cyanoacrylate[J].J Clin Gastroenterol,2002,35(9):222-227.
[8]KUMAR A,SINGH S,MADAN K,et al.Undiluted N-butyl cyanoacrylate is safe and effective for gastric variceal bleeding[J].Gastrointest Endosc,2010,72(9):721-727.
[9]SARACCO G,GIORDANINO C,ROBERTO N,et al.Fatal multiple systemic embolisms after injection of cyanoacrylate in bleeding gastric varices of a patient who was noncirrhotic but with idiopathic portal hypertension[J].Gastrointest Endosc,2007,65(11):345-347.