经皮经肝栓塞后食管胃底粘膜下及其周围静脉丛组织胶的转归研究
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摘要
目的：动态观察经皮经肝曲张静脉栓塞后食管胃底粘膜下曲张静脉、食管旁静脉和食管胃底周围静脉丛内组织胶的滞留和转归,探讨经皮经肝组织胶栓塞后食管下段和胃底部不同部位曲张血管丛组织胶的转归特点,从而明确经皮经肝组织胶介入栓塞的远期疗效机制。
方法：自2003年经皮经肝栓塞食管胃静脉曲张病人130例。其中22例于术后1-2周、2周-1月、1月-3月、6月及以后每年行动态胃镜检查并于术后3月、半年及以后每年复查上腹部CT和门静脉血管成像。本研究即是通过该22例动态随访病人的胃镜及CT结果,分析介入栓塞后食管下段和胃底部粘膜下曲张静脉丛、壁内穿支静脉及壁外周围静脉丛组织胶转归和演变特点。
结果：该22例患者动态随访47-62个月,平均56个月。胃镜复查示术后1-2周,22例患者可见食管下段被TH胶填充的曲张静脉呈条索状,质地变硬,可见其内有白色或棕褐色组织胶沉积,曲张静脉壁呈肿胀、糜烂、溃疡等炎症反应的表现,2例病例可见组织胶的少量脱失,未被TH胶栓塞的食管中上段曲张基本静脉消失或明显缓解。术后2周-1月的复查,21例可见黏膜表面呈花斑状,曲张静脉呈灶状溃疡及脱胶,但可见明显的结节样增生,被组织胶填充的上段静脉曲张消失或呈F1表现。术后1-3个月的复查,20例患者可见粘膜炎症基本消退,有少量黑色组织胶被排除,周围粘膜光滑,部分粘膜仍有颗粒感,无曲张静脉及组织胶沉积于粘膜下,或是已无组织胶排泄,只剩下黏膜下斑点状棕色组织胶沉积,静脉曲张消失或呈F1走直表现,9例病人食管下段粘膜出现表浅毛细血管,走形紊乱。术后半年,15例食管下段及胃底部粘膜光滑,无组织胶沉积及排除,静脉曲张持续稳定,食管粘膜颗粒感,粘膜下表浅纤细血管常见,粘膜无明显充血、水肿和糜烂,剩余7例胃底粘膜光滑,无组织胶沉积,而食管下段黏膜下仍有斑点状棕色组织胶沉积。术后47月-62月术后强化CT显示该组病人食管下段及胃底贲门区域粘膜下曲张静脉、胃底部穿支静脉、食管下段胃底周围静脉及旁静脉组织胶栓塞广泛,术后动态CT随访观察显示食管下段及胃底部粘膜下曲张静脉内组织胶逐渐脱落、减少,而食管下端和胃底周围静脉及穿支静脉内组织胶持续密实充填,未随时间延长而脱落、减少,腹腔内其他部位也未见有组织胶残留；动态门静脉血管成像观察显示血管栓塞充分,曲张静脉栓塞区域无血流信号,无明显血管再通表现。
结论：经皮经肝组织胶曲张静脉栓塞后食管下段和胃底粘膜下的曲张静脉出现排胶现象且静脉曲张消失；而食管下段食管旁静脉和周围静脉、胃底和贲门周围曲张静脉、胃壁内穿支静脉内组织胶充填良好,术后随访未见组织胶脱失和减少。不同部位血管丛内组织胶转归不同,不能简单的用“异物排胶”理论解释,可能与胃酸的腐蚀及食物的冲刷及其他原因相关,但还需要大量的动物实验及病理结果来证实。食管胃底周围静脉及胃底部穿支静脉内组织胶的长久栓塞和滞留是预防静脉曲张复发、保持介入栓塞持久疗效的基础和保障。
Objective:To evaluate the prognosis of the TH glue and the prostecditive efficacy after percutaneous transhepatic varices embolizationby endoscopy and CT scanning.
Methods:TH glue was injected into esophageal and gastric varices and their feeder veins in130 patients.106 patients were followed-up for evaluating the rate of re-bleeding,and 22 patients of their were followed-up for endoscopy and CT. These 22 patients need endoscopy at 1 to 2 weeks,2 to 4 weeks,1month to 3 months and 6 months after the procedure,and need CT at 3 months and 6-12 months after the procedure.
Results:The endoscopy was performed at 1-2 weeks(no changes,no Foreign Body Batchingout.),2-4weeks (21 patients'mucosa turning to ulcer and appear Foreign Body Batchingout,or F1 appearance, 1patient no change), 1-3month(the black TH glude of 20 patients' mucosa turning to be out and the mucosa turning smooth,the varices turn to disappear or F1), and 6 months after the procedure(the esophageal and gastric mucosa of 15 patients were smoonth,no TH glue,but the esophageal mucosa of 7 patients were pigmentation macularis multiplex),by the CT performed at 3 months and 6-12 months after the procedure,we know that the TH glue in the esophageal and gastric varices decreased, while the TH glue kept staying in the paraesophageal veins and para-gastric fudus veins during the follow-up. And no vessel recurrent.
Conclusion:The TH glue in the esophageal and gastric varices decreased, while the TH glue kept staying in the paraesophageal veins and para-gastric fudus veins during the follow-up. This result can't be explained completely by Foreign Body Batchingout. The inflammation and fibrosis of esophageal and gastric mucosa is the premise of disappearing of varies. while the TH glue kept staying in the paraesophageal veins and para-gastric fudus veins prevent rebleeding. The relapse rate after percutaneous transhepatic varices embolization is closely related to obliteration range.
方法：自2003年经皮经肝栓塞食管胃静脉曲张病人130例。其中22例于术后1-2周、2周-1月、1月-3月、6月及以后每年行动态胃镜检查并于术后3月、半年及以后每年复查上腹部CT和门静脉血管成像。本研究即是通过该22例动态随访病人的胃镜及CT结果,分析介入栓塞后食管下段和胃底部粘膜下曲张静脉丛、壁内穿支静脉及壁外周围静脉丛组织胶转归和演变特点。
结果：该22例患者动态随访47-62个月,平均56个月。胃镜复查示术后1-2周,22例患者可见食管下段被TH胶填充的曲张静脉呈条索状,质地变硬,可见其内有白色或棕褐色组织胶沉积,曲张静脉壁呈肿胀、糜烂、溃疡等炎症反应的表现,2例病例可见组织胶的少量脱失,未被TH胶栓塞的食管中上段曲张基本静脉消失或明显缓解。术后2周-1月的复查,21例可见黏膜表面呈花斑状,曲张静脉呈灶状溃疡及脱胶,但可见明显的结节样增生,被组织胶填充的上段静脉曲张消失或呈F1表现。术后1-3个月的复查,20例患者可见粘膜炎症基本消退,有少量黑色组织胶被排除,周围粘膜光滑,部分粘膜仍有颗粒感,无曲张静脉及组织胶沉积于粘膜下,或是已无组织胶排泄,只剩下黏膜下斑点状棕色组织胶沉积,静脉曲张消失或呈F1走直表现,9例病人食管下段粘膜出现表浅毛细血管,走形紊乱。术后半年,15例食管下段及胃底部粘膜光滑,无组织胶沉积及排除,静脉曲张持续稳定,食管粘膜颗粒感,粘膜下表浅纤细血管常见,粘膜无明显充血、水肿和糜烂,剩余7例胃底粘膜光滑,无组织胶沉积,而食管下段黏膜下仍有斑点状棕色组织胶沉积。术后47月-62月术后强化CT显示该组病人食管下段及胃底贲门区域粘膜下曲张静脉、胃底部穿支静脉、食管下段胃底周围静脉及旁静脉组织胶栓塞广泛,术后动态CT随访观察显示食管下段及胃底部粘膜下曲张静脉内组织胶逐渐脱落、减少,而食管下端和胃底周围静脉及穿支静脉内组织胶持续密实充填,未随时间延长而脱落、减少,腹腔内其他部位也未见有组织胶残留；动态门静脉血管成像观察显示血管栓塞充分,曲张静脉栓塞区域无血流信号,无明显血管再通表现。
结论：经皮经肝组织胶曲张静脉栓塞后食管下段和胃底粘膜下的曲张静脉出现排胶现象且静脉曲张消失；而食管下段食管旁静脉和周围静脉、胃底和贲门周围曲张静脉、胃壁内穿支静脉内组织胶充填良好,术后随访未见组织胶脱失和减少。不同部位血管丛内组织胶转归不同,不能简单的用“异物排胶”理论解释,可能与胃酸的腐蚀及食物的冲刷及其他原因相关,但还需要大量的动物实验及病理结果来证实。食管胃底周围静脉及胃底部穿支静脉内组织胶的长久栓塞和滞留是预防静脉曲张复发、保持介入栓塞持久疗效的基础和保障。
Objective:To evaluate the prognosis of the TH glue and the prostecditive efficacy after percutaneous transhepatic varices embolizationby endoscopy and CT scanning.
Methods:TH glue was injected into esophageal and gastric varices and their feeder veins in130 patients.106 patients were followed-up for evaluating the rate of re-bleeding,and 22 patients of their were followed-up for endoscopy and CT. These 22 patients need endoscopy at 1 to 2 weeks,2 to 4 weeks,1month to 3 months and 6 months after the procedure,and need CT at 3 months and 6-12 months after the procedure.
Results:The endoscopy was performed at 1-2 weeks(no changes,no Foreign Body Batchingout.),2-4weeks (21 patients'mucosa turning to ulcer and appear Foreign Body Batchingout,or F1 appearance, 1patient no change), 1-3month(the black TH glude of 20 patients' mucosa turning to be out and the mucosa turning smooth,the varices turn to disappear or F1), and 6 months after the procedure(the esophageal and gastric mucosa of 15 patients were smoonth,no TH glue,but the esophageal mucosa of 7 patients were pigmentation macularis multiplex),by the CT performed at 3 months and 6-12 months after the procedure,we know that the TH glue in the esophageal and gastric varices decreased, while the TH glue kept staying in the paraesophageal veins and para-gastric fudus veins during the follow-up. And no vessel recurrent.
Conclusion:The TH glue in the esophageal and gastric varices decreased, while the TH glue kept staying in the paraesophageal veins and para-gastric fudus veins during the follow-up. This result can't be explained completely by Foreign Body Batchingout. The inflammation and fibrosis of esophageal and gastric mucosa is the premise of disappearing of varies. while the TH glue kept staying in the paraesophageal veins and para-gastric fudus veins prevent rebleeding. The relapse rate after percutaneous transhepatic varices embolization is closely related to obliteration range.
引文
[1]SpenceRAJ.The venous anatomy of the lower esophagus in normal subjects and in patients with varices:An image analysis study. BrJSurg,1984,71:739-748.
[2]Boyce HW. The normal anatomy around the oesophagogastric junction:An endoscopic view. Best Practice & Research in Clinical Gastroenterology 2008;22:553-67.
[3]Sato T, Kato Y. Palisading longitudinal esophagus vessels at esophago-gastric junction. Hepato-Gastroenterology 2008;55:305-7.
[4]Vianna A, Hayes PC, Moscoso G, Driver M, Portmann B, Westaby D, et al. Normal venous circulation of the gastroesophageal junction. A route to understanding varices. Gastroenterology 1987;93:876-89.
[5]Hashizume M, Kitano S, Sugimachi K, Sueishi K.3-dimensional view of the vascular structure of the lower esophagus in clinical portal hypertension. Hepatology 1988;8:1482-7.
[6]Irisawa A, Saito A, Obara K, Shibukawa G, Takagi T, Shishido H, et al. Endoscopic recurrence of esophageal varices is associated with the specific EUS abnormalities:severe peri-esophageal collateral veins and large perforating veins. Gastrointestinal Endoscopy 2001;53:77-84.
[7]Konishi Y, Nakamura T, Kida H, Seno H, Okazaki K, Chiba T. Catheter US probe EUS evaluation of gastric cardia and perigastric vascular structures to predict esophageal variceal recurrence. Gastrointestinal Endoscopy 2002;55:197-203.
[8]Villanueva C, Colomo A, Aracil C, Guarner C. Current endoscopic therapy of variceal bleeding. Best Practice & Research in Clinical Gastroenterology 2008;22:261-78.
[9]Bengmark S,Borjesson B, Hoevels J, et al. Oblitreration of esophageal varices by PTP. Ann Surg,1979,190:549-554.
[10]Freeny PC, Kidd R. Transhepatic portal vanography and selective obliteration of gastroesophageal varices using isobutyl 2-cyanoacrylate. Dig Dis Sci, 1979,24:321-330.
[11]彭涌,马中,宁莫凡,等.应用TH胶行胃冠状静脉栓塞治疗门静脉高压症的临床疗效分析.第四军医大学学报,2001,22：1342—1344.
[12]黄志强,主编.腹部外科手术学.湖南：湖南科学技术出版社,2004：714-717.
[13]效恭,王英,李国成,等.直视下胃冠状静脉栓塞、脾切除治疗门静脉高压症.中华外科杂志,1986,24：648-651.
[14]Seewald S, Sriam P, Naga M, et al. Cyanoacrylate Glue in gastric Variceal Bleeding. Endoscopy,2002,34:926-932
[15]Vinuela F, DionJE, Duckwiler G, et al. Combined endovascular embolization and surgery in the management of cerebral arteriovenous malformations:experience with 101 cases. J Neurosurg 1991; 75:856-864.
[16]Pelz DM, Fox AJ, Vinuela E et al. Preoperative embolization of brain AVMs with isobutyl-2-cyanoacrylate. AmJ Neuroradiol 1988; 9:757-764.
[17]Pasqualin A, Scienza R, Cioffi F, et al. Treatment of cerebral arteriovenous malformations with a combination of preoperative embolization and surgery. Neurosurgery 1991; 29:358-368.
[18]Grzyska U, Westphal M, Zanella F, Freckmann N, Herrmann HD, Zeumer H. A joint protocol for the neurosurgical and neuroradiologic treatment of cerebral arteriovenous malformations:indications, technique and results in 76 cases. Surg Neurol 1993; 40:476-484.
[19]Dawson RC, Tarr RW, Hecht ST, et al. Treatment of arteriovenous malformations of the brain with combined embolization and stereotactic radiosurgery:results after 1 and 2 years. AmJ Neuroradiol 11:857-864,1990.
[20]Brothers MF, Kaufmann JC, Fox AJ, Deveikis JP:n-Butyl-2-cya-noacrylate:Substitute for IBCA in interventional neuroradiolo-gy-Histopathologic and polymerization time studies. AJNRAm J Neuroradiol 10:777-786,1989.
[21]Cromwell L, Freeny P, Kerber C, Kunz L, Harris A, Shaw C:Histologic analysis of tissue response to bucrylate-Pantopaquemixture. AJNR Am J Neuroradiol 14:627-631,1986.
[22]Kish K, Rapp S, Wilner H, Wolfe D, Thomas L, Barr J: Histopatho-logic effects of transarterial bucrylate occlusion of intracerebralarteries in mongrel dogs. AJNR Am J Neuroradiol 4:385-387,1983.
[23]Klara PM, George ED, McDonnell DE, Pevsner PH: Morphologicalstudies of human arteriovenous malformations: Effects of isobutyl2-cyanoacrylate embolization. J Neurosurg 63:421-425,1985.
[24]Lylyk P, Vin~ uela F, Vinters HV, Dion J, Bentson J, Duckwiler G, Lin T:Use of a new mixture for embolization of intracranialvascular malformations:Preliminary experimental experience. Neuroradiology 32:304-310,1990.
[25]Vinters HV, Galil KA, Lundie MJ, Kaufmann JC:The histotoxicity ofcyanoacrylates:A selective review. Neuroradiology 27:279-291, 1985.
[26]Vinters HV, Lundie MJ, Kaufmann JCE:Long-term pathologicalfollow-up of cerebral arteriovenous malformations treated byembolization with bucrylate. N Engl J Med 314:477-483,1986.
[27]Zanetti P, Sherman F:Experimental evaluation of a tissue adhe-sive as an agent for the treatment of aneurysms and arteriovenousanomalies. J Neurosurg 36:72-79,1972.
[28]Yan-Mei Wang, Liu-Fang Cheng, Nan Li, Kai Wu, Jun-Shan Zhai, Ya-Wen Wang. Study of glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding[J]. World J Gastroenterol 2009 October 21; 15(39):4945-4951.
[1]SpenceRAJ.The venous anatomy of the lower esophagus in normal subjects and in patients with varices:An image analysis study. BrJSurg,1984,71:739-748.
[2]Irisawa A, Saito A, Obara K, Shibukawa G, Takagi T, Shishido H, et al. Endoscopic recurrence of esophageal varices is associated with the specific EUS abnormalities:severe peri-esophageal collateral veins and large perforating veins. Gastrointestinal Endoscopy 2001;53:77-84.
[3]Konishi Y, Nakamura T, Kida H, Seno H, Okazaki K, Chiba T. Catheter US probe EUS evaluation of gastric cardia and perigastric vascular structures to predict esophageal variceal recurrence. Gastrointestinal Endoscopy 2002;55:197-203.
[4]Villanueva C, Colomo A, Aracil C, Guarner C. Current endoscopic therapy of variceal bleeding. Best Practice & Research in Clinical Gastroenterology 2008;22:261-78.
[5]Bengmark S,Borjesson B, Hoevels J, et al. Oblitreration of esophageal varices by PTP. Ann Surg,1979,190:549-554.
[6]Freeny PC, Kidd R. Transhepatic portal vanography and selective obliteration of gastroesophageal varices using isobutyl 2-cyanoacrylate. Dig Dis Sci, 1979,24:321-330.
[7]彭涌,马中,宁莫凡,等.应用TH胶行胃冠状静脉栓塞治疗门静脉高压症的临床疗效分析.第四军医大学学报,2001,22：1342—1344.
[8]黄志强,主编.腹部外科手术学.湖南：湖南科学技术出版社,2004：714-717.
[9]效恭,王英,李国成,等.直视下胃冠状静脉栓塞、脾切除治疗门静脉高压症.中华外科杂志,1986,24：648-651.
[10]Seewald S, Sriam P, Naga M, et al. Cyanoacrylate Glue in gastric Variceal Bleeding. Endoscopy,2002,34:926-932
[11]Lunderquist A, Vang J.Transhepatic catheterization and obliteration of the coronary vein in patients with portal hypertension and esophageal varices[J].N Engl J Med,1974,291(13):646-9.
[12]张春清,刘福利,梁波,等.经皮经肝组织粘合剂栓塞治疗食管静脉曲张的疗效观察[J].中华消化内镜杂志,2007,24(4)：254-7.
[13]张春清,许洪伟,刘福利,等.经皮经肝TH胶“三明治”栓塞术治疗食管胃底静脉曲张[J].医学影像学杂志,2006,16(1)：45-7.
[14]李选,孙鹏,李学通.急诊经皮经肝食管胃底静脉栓塞治疗重度肝硬化消化道出血.介入放射学杂志,2002,11：89-91.
[15]钱林学,王宝恩.联合导向下经皮经肝胃冠状静脉栓塞治疗食管胃底静脉曲张出血.中华肝脏病杂志,2003,11：667-668.
[16]Vinuela F, DionJE, Duckwiler G, et al. Combined endovascular embolization and surgery in the management of cerebral arteriovenous malformations:experience with 101 cases.J Neurosurg 1991; 75:856-864.
[17]Pelz DM, Fox AJ, Vinuela E et al. Preoperative embolization of brain AVMs with isobutyl-2-cyanoacrylate. AmJ Neuroradiol 1988; 9:757-764.
[18]Pasqualin A, Scienza R, Cioffi F, et al. Treatment of cerebral arteriovenous malformations with a combination of preoperative embolization and surgery. Neurosurgery 1991; 29:358-368.
[19]Grzyska U, Westphal M, Zanella F, Freckmann N, Herrmann HD, Zeumer H. A joint protocol for the neurosurgical and neuroradiologic treatment of cerebral arteriovenous malformations: indications, technique and results in 76 cases. Surg Neurol 1993; 40:476-484.
[20]Dawson RC, Tarr RW, Hecht ST, et al. Treatment of arteriovenous malformations of the brain with combined embolization and stereotactic radiosurgery:results after 1 and 2 years. AmJ Neuroradiol 11:857-864,1990.
[21]Brothers MF, Kaufmann JC, Fox AJ, Deveikis JP:n-Butyl-2-cya-noacrylate:Substitute for IBCA in interventional neuroradiolo-gy-Histopathologic and polymerization time studies. AJNRAm J Neuroradiol 10:777-786,1989.
[22]Cromwell L, Freeny P, Kerber C, Kunz L, Harris A, Shaw C:Histologic analysis of tissue response to bucrylate-Pantopaquemixture. AJNR Am J Neuroradiol 14:627-631,1986.
[23]Kish K, Rapp S, Wilner H, Wolfe D, Thomas L, Barr J: Histopatho-logic effects of transarterial bucrylate occlusion of
intracerebralarteries in mongrel dogs. AJNR Am J Neuroradiol 4:385-387,1983.
[24]Klara PM, George ED, McDonnell DE, Pevsner PH: Morphologicalstudies of human arteriovenous malformations: Effects of isobutyl2-cyanoacrylate embolization. J Neurosurg 63:421-425,1985.
[25]Lylyk P, Vin~ uela F, Vinters HV, Dion J, Bentson J, Duckwiler G, Lin T:Use of a new mixture for embolization of intracranialvascular malformations:Preliminary experimental experience. Neuroradiology 32:304-310,1990.
[26]Vinters HV, Galil KA, Lundie MJ, Kaufmann JC:The histotoxicity ofcyanoacrylates:A selective review. Neuroradiology 27:279-291, 1985.
[27]Vinters HV, Lundie MJ, Kaufmann JCE:Long-term pathologicalfollow-up of cerebral arteriovenous malformations treated byembolization with bucrylate. N Engl J Med 314:477-483, 1986.
[28]Zanetti P, Sherman F:Experimental evaluation of a tissue adhe-sive as an agent for the treatment of aneurysms and arteriovenousanomalies. J Neurosurg 36:72-79,1972.
[2]Boyce HW. The normal anatomy around the oesophagogastric junction:An endoscopic view. Best Practice & Research in Clinical Gastroenterology 2008;22:553-67.
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[7]Konishi Y, Nakamura T, Kida H, Seno H, Okazaki K, Chiba T. Catheter US probe EUS evaluation of gastric cardia and perigastric vascular structures to predict esophageal variceal recurrence. Gastrointestinal Endoscopy 2002;55:197-203.
[8]Villanueva C, Colomo A, Aracil C, Guarner C. Current endoscopic therapy of variceal bleeding. Best Practice & Research in Clinical Gastroenterology 2008;22:261-78.
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[11]彭涌,马中,宁莫凡,等.应用TH胶行胃冠状静脉栓塞治疗门静脉高压症的临床疗效分析.第四军医大学学报,2001,22：1342—1344.
[12]黄志强,主编.腹部外科手术学.湖南：湖南科学技术出版社,2004：714-717.
[13]效恭,王英,李国成,等.直视下胃冠状静脉栓塞、脾切除治疗门静脉高压症.中华外科杂志,1986,24：648-651.
[14]Seewald S, Sriam P, Naga M, et al. Cyanoacrylate Glue in gastric Variceal Bleeding. Endoscopy,2002,34:926-932
[15]Vinuela F, DionJE, Duckwiler G, et al. Combined endovascular embolization and surgery in the management of cerebral arteriovenous malformations:experience with 101 cases. J Neurosurg 1991; 75:856-864.
[16]Pelz DM, Fox AJ, Vinuela E et al. Preoperative embolization of brain AVMs with isobutyl-2-cyanoacrylate. AmJ Neuroradiol 1988; 9:757-764.
[17]Pasqualin A, Scienza R, Cioffi F, et al. Treatment of cerebral arteriovenous malformations with a combination of preoperative embolization and surgery. Neurosurgery 1991; 29:358-368.
[18]Grzyska U, Westphal M, Zanella F, Freckmann N, Herrmann HD, Zeumer H. A joint protocol for the neurosurgical and neuroradiologic treatment of cerebral arteriovenous malformations:indications, technique and results in 76 cases. Surg Neurol 1993; 40:476-484.
[19]Dawson RC, Tarr RW, Hecht ST, et al. Treatment of arteriovenous malformations of the brain with combined embolization and stereotactic radiosurgery:results after 1 and 2 years. AmJ Neuroradiol 11:857-864,1990.
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[22]Kish K, Rapp S, Wilner H, Wolfe D, Thomas L, Barr J: Histopatho-logic effects of transarterial bucrylate occlusion of intracerebralarteries in mongrel dogs. AJNR Am J Neuroradiol 4:385-387,1983.
[23]Klara PM, George ED, McDonnell DE, Pevsner PH: Morphologicalstudies of human arteriovenous malformations: Effects of isobutyl2-cyanoacrylate embolization. J Neurosurg 63:421-425,1985.
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[28]Yan-Mei Wang, Liu-Fang Cheng, Nan Li, Kai Wu, Jun-Shan Zhai, Ya-Wen Wang. Study of glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding[J]. World J Gastroenterol 2009 October 21; 15(39):4945-4951.
[1]SpenceRAJ.The venous anatomy of the lower esophagus in normal subjects and in patients with varices:An image analysis study. BrJSurg,1984,71:739-748.
[2]Irisawa A, Saito A, Obara K, Shibukawa G, Takagi T, Shishido H, et al. Endoscopic recurrence of esophageal varices is associated with the specific EUS abnormalities:severe peri-esophageal collateral veins and large perforating veins. Gastrointestinal Endoscopy 2001;53:77-84.
[3]Konishi Y, Nakamura T, Kida H, Seno H, Okazaki K, Chiba T. Catheter US probe EUS evaluation of gastric cardia and perigastric vascular structures to predict esophageal variceal recurrence. Gastrointestinal Endoscopy 2002;55:197-203.
[4]Villanueva C, Colomo A, Aracil C, Guarner C. Current endoscopic therapy of variceal bleeding. Best Practice & Research in Clinical Gastroenterology 2008;22:261-78.
[5]Bengmark S,Borjesson B, Hoevels J, et al. Oblitreration of esophageal varices by PTP. Ann Surg,1979,190:549-554.
[6]Freeny PC, Kidd R. Transhepatic portal vanography and selective obliteration of gastroesophageal varices using isobutyl 2-cyanoacrylate. Dig Dis Sci, 1979,24:321-330.
[7]彭涌,马中,宁莫凡,等.应用TH胶行胃冠状静脉栓塞治疗门静脉高压症的临床疗效分析.第四军医大学学报,2001,22：1342—1344.
[8]黄志强,主编.腹部外科手术学.湖南：湖南科学技术出版社,2004：714-717.
[9]效恭,王英,李国成,等.直视下胃冠状静脉栓塞、脾切除治疗门静脉高压症.中华外科杂志,1986,24：648-651.
[10]Seewald S, Sriam P, Naga M, et al. Cyanoacrylate Glue in gastric Variceal Bleeding. Endoscopy,2002,34:926-932
[11]Lunderquist A, Vang J.Transhepatic catheterization and obliteration of the coronary vein in patients with portal hypertension and esophageal varices[J].N Engl J Med,1974,291(13):646-9.
[12]张春清,刘福利,梁波,等.经皮经肝组织粘合剂栓塞治疗食管静脉曲张的疗效观察[J].中华消化内镜杂志,2007,24(4)：254-7.
[13]张春清,许洪伟,刘福利,等.经皮经肝TH胶“三明治”栓塞术治疗食管胃底静脉曲张[J].医学影像学杂志,2006,16(1)：45-7.
[14]李选,孙鹏,李学通.急诊经皮经肝食管胃底静脉栓塞治疗重度肝硬化消化道出血.介入放射学杂志,2002,11：89-91.
[15]钱林学,王宝恩.联合导向下经皮经肝胃冠状静脉栓塞治疗食管胃底静脉曲张出血.中华肝脏病杂志,2003,11：667-668.
[16]Vinuela F, DionJE, Duckwiler G, et al. Combined endovascular embolization and surgery in the management of cerebral arteriovenous malformations:experience with 101 cases.J Neurosurg 1991; 75:856-864.
[17]Pelz DM, Fox AJ, Vinuela E et al. Preoperative embolization of brain AVMs with isobutyl-2-cyanoacrylate. AmJ Neuroradiol 1988; 9:757-764.
[18]Pasqualin A, Scienza R, Cioffi F, et al. Treatment of cerebral arteriovenous malformations with a combination of preoperative embolization and surgery. Neurosurgery 1991; 29:358-368.
[19]Grzyska U, Westphal M, Zanella F, Freckmann N, Herrmann HD, Zeumer H. A joint protocol for the neurosurgical and neuroradiologic treatment of cerebral arteriovenous malformations: indications, technique and results in 76 cases. Surg Neurol 1993; 40:476-484.
[20]Dawson RC, Tarr RW, Hecht ST, et al. Treatment of arteriovenous malformations of the brain with combined embolization and stereotactic radiosurgery:results after 1 and 2 years. AmJ Neuroradiol 11:857-864,1990.
[21]Brothers MF, Kaufmann JC, Fox AJ, Deveikis JP:n-Butyl-2-cya-noacrylate:Substitute for IBCA in interventional neuroradiolo-gy-Histopathologic and polymerization time studies. AJNRAm J Neuroradiol 10:777-786,1989.
[22]Cromwell L, Freeny P, Kerber C, Kunz L, Harris A, Shaw C:Histologic analysis of tissue response to bucrylate-Pantopaquemixture. AJNR Am J Neuroradiol 14:627-631,1986.
[23]Kish K, Rapp S, Wilner H, Wolfe D, Thomas L, Barr J: Histopatho-logic effects of transarterial bucrylate occlusion of
intracerebralarteries in mongrel dogs. AJNR Am J Neuroradiol 4:385-387,1983.
[24]Klara PM, George ED, McDonnell DE, Pevsner PH: Morphologicalstudies of human arteriovenous malformations: Effects of isobutyl2-cyanoacrylate embolization. J Neurosurg 63:421-425,1985.
[25]Lylyk P, Vin~ uela F, Vinters HV, Dion J, Bentson J, Duckwiler G, Lin T:Use of a new mixture for embolization of intracranialvascular malformations:Preliminary experimental experience. Neuroradiology 32:304-310,1990.
[26]Vinters HV, Galil KA, Lundie MJ, Kaufmann JC:The histotoxicity ofcyanoacrylates:A selective review. Neuroradiology 27:279-291, 1985.
[27]Vinters HV, Lundie MJ, Kaufmann JCE:Long-term pathologicalfollow-up of cerebral arteriovenous malformations treated byembolization with bucrylate. N Engl J Med 314:477-483, 1986.
[28]Zanetti P, Sherman F:Experimental evaluation of a tissue adhe-sive as an agent for the treatment of aneurysms and arteriovenousanomalies. J Neurosurg 36:72-79,1972.