内镜下密集套扎术与组织粘合剂注入术联合治疗胃食管静脉曲张出血的临床研究
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摘要
胃食管静脉曲张(gastroesophageal varices, GOV)出血是由于肝硬化等病变引起的门静脉高压,致使食管和(或)胃壁静脉曲张,当压力升高或静脉壁发生损伤时,曲张静脉发生破裂出血；GOV出血的病因可见于所有引起门静脉高压的疾病,肝硬化、肝癌、先天性肝纤维变性等,在我国以肝硬化最为常见。
GOV出血是肝硬化最常见的并发症,极易出现致命性消化道大出血,是临床上常见的危重症。对于单纯食管静脉曲张(esophageal varices, EV),经内镜套扎治疗(endoscopic variceal ligation, EVL)已取得较好疗效；对于不伴有EV的胃底静脉曲张(fundalgastricvarices, GV),应用组织粘合剂栓塞也取得肯定的疗效。临床上最为棘手的是同时出现GOV,此时仅行EVL术将导致GV加重,而仅行胃底栓塞术不能有效地控制食管静脉曲张出血(esophageal variceal bleeding, EVB),为此,我们尝试采取组织粘合剂栓塞GV联合内镜下密集套扎术(the dense endoscopic variceal ligation, DEVL)治疗EV,即从齿状线开始沿每条静脉顺序向上尽量多点套扎,并取得较好疗效。
Variceal hemorrhage is the most devastating complication of portal hypertension and it is also the major reason of the upper digestive tract bleeding. Variceal band ligation was performed using in esophageal varices, the tissue adhesive injection was used in fundalgastric varices, in our research we use the dense endoscopic variceal ligation replace the endoscopic variceal ligation and combine the tissue adhesive injection therapy the fundalgastric varices. Objective
To evaluate the clinical effect of tissue adhesive a-cyanoacrylate allkyl injection accompanied by the dense Esophageal varices ligation (DEVL) in the treatment of gastroesophageal varices bleeding. Methods:
51 cases of gastroesophageal varices, Gastric fundus varices received tissue adhesive injection(using sandwich method) and esophageal varices received DEVL.
Results.-
The insteneous hemostatic rates were 100% and no serious complications were found.
Conclusion
The treatment of tissue adhesive injection combined the dense endoscopic variceal ligation for the gastroesophageal varices bleeding is effective and safe.
GOV出血是肝硬化最常见的并发症,极易出现致命性消化道大出血,是临床上常见的危重症。对于单纯食管静脉曲张(esophageal varices, EV),经内镜套扎治疗(endoscopic variceal ligation, EVL)已取得较好疗效；对于不伴有EV的胃底静脉曲张(fundalgastricvarices, GV),应用组织粘合剂栓塞也取得肯定的疗效。临床上最为棘手的是同时出现GOV,此时仅行EVL术将导致GV加重,而仅行胃底栓塞术不能有效地控制食管静脉曲张出血(esophageal variceal bleeding, EVB),为此,我们尝试采取组织粘合剂栓塞GV联合内镜下密集套扎术(the dense endoscopic variceal ligation, DEVL)治疗EV,即从齿状线开始沿每条静脉顺序向上尽量多点套扎,并取得较好疗效。
Variceal hemorrhage is the most devastating complication of portal hypertension and it is also the major reason of the upper digestive tract bleeding. Variceal band ligation was performed using in esophageal varices, the tissue adhesive injection was used in fundalgastric varices, in our research we use the dense endoscopic variceal ligation replace the endoscopic variceal ligation and combine the tissue adhesive injection therapy the fundalgastric varices. Objective
To evaluate the clinical effect of tissue adhesive a-cyanoacrylate allkyl injection accompanied by the dense Esophageal varices ligation (DEVL) in the treatment of gastroesophageal varices bleeding. Methods:
51 cases of gastroesophageal varices, Gastric fundus varices received tissue adhesive injection(using sandwich method) and esophageal varices received DEVL.
Results.-
The insteneous hemostatic rates were 100% and no serious complications were found.
Conclusion
The treatment of tissue adhesive injection combined the dense endoscopic variceal ligation for the gastroesophageal varices bleeding is effective and safe.
引文
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