球囊逆行静脉阻断术联合内镜注射治疗胃肾分流静脉曲张患者3例

球囊阻断经逆行静脉闭塞术(balloon retrograde venous occlusion,BRTO)是治疗胃肾分流的胃底静脉曲张的主要方法,能有效防止异位栓塞[1-3],但是,逆行静脉注射硬化剂可能存在胃底静脉曲张消失不完全,需再次胃镜下注射治疗[4]。单纯胃镜下注射硬化治疗,由于存在分流通道,异位栓塞的风险较高。因此,我们采用了改良球囊逆行静脉阻断术联合胃镜下注射硬化治疗胃肾分流胃底静脉曲张患者3例,现报道如下。     

经皮经肝α-氰基丙烯酸正丁酯胶和生物蛋白胶联合栓塞治疗食管胃底静脉曲张20例

目的介绍经皮经肝α-氰基丙烯酸正丁酯(NBCA胶,n-butyl-2-cyanoacrylate)和生物蛋白胶联合栓塞食管胃底静脉曲张的应用。方法采用经皮经肝NBCA胶和生物蛋白胶联合栓塞胃冠状静脉和胃短静脉为主的方法治疗门静脉高压食管胃底静脉曲张患者20例,生物蛋白胶以栓塞胃部曲张静脉的流出端为主,NBCA胶栓塞胃部曲张静脉的主体和输入段,部分加用弹簧圈栓塞减慢血流。15例患者同时行部分性脾动脉栓塞。结果栓塞成功16例(80%),术后即刻食管胃底曲张静脉血流消失而且出血控制。随访1~11个月(平均4.3个月),成功栓塞的16例患者无1例发生再出血,其中胃镜复查11例,5例曲张静脉基本消失,4例明显减轻,2例稍有减轻。4例患者曲张静脉内NBCA充填不充分,致使栓塞不彻底,其中2例发生再出血。无1患者发生异位栓塞和胃黏膜的过度栓塞。结论经皮经肝NBCA胶和生物蛋白胶联合栓塞食管胃底静脉曲张可有效防止异位栓塞及过度栓塞,安全而且疗效确切,可作为治疗食管胃底静脉曲张破裂急性出血的重要治疗手段之一。能否彻底栓塞是决定疗效的主要因素。     

腔内泡沫硬化治疗食管胃底静脉曲张临床疗效研究

目的 评估经门静脉分支由导管腔内灌注泡沫硬化剂治疗食管胃底静脉曲张的安全性和有效性。方法 回顾性收集2019年5月至2021年9月广州市番禺区中心医院23例经门静脉入路行食管胃底曲张静脉泡沫硬化治疗的患者,术后3个月内至少完成1次胃镜及腹部CT,总结技术成功率、总生存率、不良反应及预后情况(再出血发生率、血管再通率、新侧枝生成率)。结果 23例患者行门静脉造影均可见食管胃底静脉曲张,合并自发性门腔分流1例,均成功行经颈静脉肝内门体分流术及泡沫硬化术,术后门腔静脉压力梯度降低至(11.78+2.28)mm Hg,肺栓塞相关症状发生率2例,无影像学肺栓塞发生,技术成功率100%。平均随访时间(18.50+8.41)个月,无出血发生率91.30%(21例),CT评估均无血管再通,新生侧枝生成率4.34%(1例),累计生存率为86.96%(20例),胃镜下曲张静脉缓解率100%,消失率78.26%(18例)。结论 经导管腔内泡沫硬化治疗食管胃底静脉曲张可使血管硬化闭塞,是一种安全、有效的方法。     

合并胃肾分流道的胃静脉曲张临床诊疗经验

目的 总结合并胃肾分流道的胃静脉曲张临床诊疗经验。方法 回顾性分析解放军总医院第一医学中心消化内科医学部2016年1月至2021年12月期间收治的合并胃肾分流道的胃静脉曲张患者的临床资料。结果 共纳入患者30例,男13例、女17例,平均年龄(56.7±8.62)岁,孤立性胃静脉曲张9例、伴食管静脉曲张者21例,病因均为肝硬化所致门静脉高压,Child-Pugh A级8例、Child-Pugh B级21例、Child-Pugh C级1例,门静脉主干直径(11.8±2.33)mm,胃肾分流道最宽处直径(13.7±4.74)mm。所有患者均成功进行了数字减影血管造影(DSA)下胃肾分流道球囊临时封堵术联合内镜下胃静脉曲张组织胶注射治疗,9例合并食管静脉曲张的患者同时行食管静脉曲张套扎治疗。术后3例患者出现发热,5例患者出现腹痛不适,所有患者均未出现组织胶异位栓塞的情况(0.0%)。术后1年内再发出血率6.7%、生存率为100%。结论 对于合并胃肾分流道的胃静脉曲张患者,联合DSA下胃肾分流道球囊临时封堵术,可有效降低内镜下组织胶注射治疗时异位栓塞的风险。     

应用聚桂醇经BRTO治疗孤立性胃底静脉曲张23例

目的:评价应用聚桂醇经球囊导管逆行经静脉栓塞(balloon-occluded retrograde transvenous obliteration,BRTO)治疗孤立性胃底静脉曲张(isolated gastric varices,IGV)的疗效及安全性.方法:回顾性分析2009-11/2012-09我院伴有胃肾分流的IGV患者23例,应用聚桂醇进行BRTO治疗,观察其疗效及安全性.结果:经BRTO治疗成功患者21例.术中3例患者发生低血压及窦性心动过缓,后经多巴胺及山莨菪碱等药物治疗及撤除球囊压迫后好转.术后无腹水及肝肾功能的加重.术后3mo胃镜复查静脉曲张消失13例,明显减轻6例,无改变2例.患者随访3-18mo,无消化系出血发生.结论:应用聚桂醇经BRTO治疗伴有胃肾分流的孤立性胃底静脉曲张,具有良好的临床疗效和安全性.     

球囊辅助下经皮经肝曲张静脉组织胶栓塞治疗孤立胃底静脉曲张

目的评估球囊辅助下经皮经肝曲张血管组织胶栓塞术治疗合并胃肾分流的孤立胃底静脉曲张的疗效及安全性。 方法选取2010年3月至2015年6月,存在合并胃肾分流的孤立胃底静脉曲张,在山东大学附属省立医院消化内科住院,并在经肾静脉行分流道球囊闭塞后,行经皮经肝曲张血管组织胶栓塞术的30例患者纳入回顾性分析,总结技术成功率、临床成功率、并发症发生情况以及随访情况。 结果30例患者均成功行组织胶栓塞术,技术成功率为100%(30/30)。除1例发生无症状的肺栓塞外,未见其他严重并发症。平均随访30个月,再出血发生率为4/30(13.3%),食管静脉曲张加重发生率为4/30(13.3%),新发腹水或腹水加重发生率为3/30(10%)。术后1、2、3、5年的累计生存率分别为96.3%、96.3%、79.9%、79.9%。 结论球囊辅助下经皮经肝曲张血管组织胶栓塞术治疗合并胃肾分流的孤立胃底静脉曲张安全可行,疗效可靠,是该类曲张出血的有用替代方案。     

门-体分流程度评估血吸虫病肝硬化上消化道出血的应用

目的探讨门-体静脉分流程度在评估血吸虫病肝硬化上消化道出血中的应用。方法以金山医院经临床证实的33例血吸虫病肝硬化上消化道出血患者,及29例血吸虫病肝硬化非出血患者为研究对象,对其进行上腹部128层螺旋CT扫描。采用薄层块最大强度投影(TSMIP)、多平面重建(MPR)对门静脉系进行血管重建,对两组患者门-体静脉分流程度进行评分和比较,分析各侧支血管分流程度与血吸虫病肝硬化上消化道出血的关系。结果 33例上消化道出血患者中,侧支血管发生率如下:胃左静脉曲张86.4%、胃短静脉曲张68.2%、食管静脉曲张50.0%、食管旁静脉曲张50.0%、胃底静脉曲张37.9%、胃肾静脉69.7%、脾肾静脉51.5%、腹壁静脉曲张25.8%、网膜静脉曲张15.2%、脾周静脉曲张63.6%、附脐静脉曲张34.8%、腹膜后-椎旁静脉40.9%、肠系膜静脉曲张36.4%。出血组食管静脉、食管旁静脉、胃左静脉和胃底静脉的发生率和分流程度均明显大于非出血组(P值均0.05)。结论 CT门静脉系成像可精确显示各类侧支血管的部位、程度及走向。食管静脉、食管旁静脉、胃左静脉和胃底静脉能较准确地预测血吸虫病肝硬化上消化道出血的风险情况,上述侧支血管分流程度越高,上消化道出血危险性就越大。     

球囊导管栓塞治疗门脉高压症食管胃静脉曲张破裂出血的近期疗效

目的探讨球囊导管栓塞食管胃曲张静脉联合部分脾动脉栓塞(PSE)对门静脉血流动力学的影响,评价其治疗食管胃静脉曲张破裂出血的疗效。方法64例门静脉高压伴食管和(或)胃曲张静脉破裂出血患者,行经皮经肝曲张静脉栓塞术(PTVE),注入无水乙醇和明胶海绵,32例在注入栓寒剂前充盈球囊导管(球囊导管组),另32例不充盈者为对照组,两组均联合PSE。球囊导管组中活动性出血行急症手术者17例,对照组中活动性出血行急症手术者16例。术中直接测门静脉压力。术前、术后彩色多普勒超声测门静脉、脾静脉血流量。数值变量行方差分析和t检验。再出血率和生存率行Kaplan-Meier分析。结果球囊导管栓塞成功率为86.8%,曲张静脉完全栓塞率为100%;对照组PTVE成功率为97.0%,曲张静脉完全栓塞率为87.5%。活动性出血止血率两组均为100%。球囊导管栓塞组曲张静脉栓塞前、后门静脉压力分别为(37.2±1.2)和(41.4±1.1)cm H2O,联合PSE后为(36.7±1.1)cm H2O,对照组分别为(37.2±1.1)、(41.3±1.1)和(36.8±1.1)cm H2O。球囊导管组栓塞前、后门静脉血流量分别为(14.8±1.2)和(14.7±1.1)ml/s(P>0.05),脾静脉血流量分别为(11.8±0.7)和(9.6±0.9)ml/s(P< 0.05);对照组分别为(14.7±1.2)和(14.7±1.2)ml/s(P>0.05),(11.8±0.8)和(9.6±0.9)ml/s(P< 0.05)。球囊导管组6周、12个月再出血率分别为0、6.2%,平均随访774.9 d,曲张静脉再出血率为31.2%.中位再出血时间为832 d;对照组6周、12个月再出血率分别为0、12.5%,平均随访629.3 d,曲张静脉再出血率43.8%,中位再出血时间668 d。球囊导管组出血病死率为15.6%,对照组为25.0%。结论应用球囊导管栓塞食管胃曲张静脉是治疗门静脉高压食管胃曲张静脉出血的有效方法之一。     

聚桂醇联合组织胶治疗肝硬化胃静脉曲张的近远期疗效

背景肝硬化患者胃静脉曲张出血的发病率、死亡率较高,套扎、组织胶注射和硬化治疗是目前治疗胃静脉出血的有效方法.目的本研究旨在评价胃镜下聚桂醇联合组织胶治疗肝硬化胃静脉曲张的近、远期疗效及安全性.方法回顾性分析2013-11/2018-10于重庆医科大学附属第二医院行胃镜下聚桂醇联合组织胶治疗胃静脉曲张肝硬化患者的临床资料,共计93例,对其静脉曲张改善情况、术后异位栓塞、再出血情况、不良反应、生存及预后等进行总结分析,并与国内外文献报道的碘油联合组织胶治疗术后情况进行比较.结果所有患者术后中位随访时间为29.5mo(1-58mo),胃静脉曲张有效率和显效率分别为47.31%(44/93)和36.56%(34/93),高于文献报道.总体再出血率为34.41%[32/93,其中早期再出血率为1.08%(1/93)].排胶出血率2.15%(2/93),胃静脉曲张破裂再出血率9.68%(9/93),溃疡出血率4.3%(4/93).6mo生存率为97.85%(91/93),12mo生存率为96.77%(90/93),18mo生存率为94.62%(88/93).术前有68例行腹部CT静脉造影检查,证实有11例患者存在胃肾、脾肾等分流,术后异位栓塞发生率为0%.以上所有术后随访指标均优于文献报道的碘油联合组织胶的疗效指标.结论聚桂醇联合组织胶治疗在改善肝硬化胃静脉曲张方面优于碘油联合组织胶,且不会增加合并分流的肝硬化胃静脉曲张患者术后发生异位栓塞的风险.     

胃冠状、胃短静脉栓塞术对胃底静脉曲张出血疗效评价

目的探讨胃冠状静脉、胃短静脉栓塞术对胃底静脉曲张出血治疗的价值。方法32例肝硬化并食管胃底静脉曲张出血经内镜下套扎、硬化治疗后仍有出血的患者，经皮经肝穿刺行胃冠状静脉、胃短静脉栓塞治疗。栓塞剂主要为无水乙醇、钢圈和明胶海绵。均行1次栓塞治疗，并经3～11个月随访，胃镜复查。结果29例复查胃镜，其中21例(72．4％)胃底曲张静脉完全消失，8例(27．6％)胃底曲张静脉明显减轻，无红色征及糜烂。随访期内有1例(3．1％)因门脉高压性胃炎致黏膜糜烂出血。未发现明显并发症。结论经皮经肝穿刺行胃冠状静脉、胃短静脉栓塞治疗具有消除胃底静脉曲张，并可预防出血的作用。     

Efficacy and safety of balloon-occluded endoscopic injection sclerotherapy as a prophylactic treatment for high-risk gastric fundal varices: a prospective,randomized, comparative clinical trial

BACKGROUND: No single effective method has yet been established for the prophylactic treatment of gastric fundal varices at high risk for bleeding. A prospective, randomized trial was conducted to compare the efficacy and safety of a new technique, balloon-occluded endoscopic injection sclerotherapy (BO-EIS), to balloon-occluded retrograde transvenous obliteration (B-RTO) for treatment of high-risk gastric fundal varices. METHODS: Twenty consecutive patients with gastric variceal diameters of over 5 mm by color Doppler EUS were randomized to undergo either BO-EIS or B-RTO. All patients underwent color Doppler EUS 2 weeks after treatment and EGD every 3 months for assessment of sclerosing effect. RESULTS: The gastric varices in all patients except one in the B-RTO group were eradicated with either treatment. The volume of sclerosant used was significantly smaller in patients who underwent BO-EIS (p < 0.05). The endoscopic grade of esophageal varices in 4 of 9 patients worsened after treatment with B-RTO (p < 0.05). The method of randomization used resulted in an uneven distribution of women, although the difference between the groups was not statistically significant. When only men were compared, the results of the study were unchanged. CONCLUSIONS: BO-EIS is a safe and effective for treatment of high-risk gastric fundal varices. In contrast to B-RTO, it can be used even in patients without a gastrorenal shunt.     

Balloon catheter-assisted endoscopic sclerotherapy for gastric fundal varices using alpha-cyanoacrylate monomer

We present two patients with bleeding episodes from gastric fundal varices. The gastric fundal varices were treated by balloon catheter-assisted endoscopic sclerotherapy using alpha-cyanoacrylate monomer. The varices were successfully obliterated with no complications or hemodynamic changes to the gastrorenal shunts. This procedure may be considered a novel, feasible approach to the treatment of gastric fundal varices in the future.     

Balloon-occluded retrograde transvenous obliteration of high risk gastric fundal varices

OBJECTIVE: Balloon-occluded retrograde transvenous obliteration is an effective new method for treating gastric fundal varices, but subsequent occurrence of esophageal varices creates a problem. The relationship between portal hemodynamics and the occurrence of esophageal varices after prophylactic balloon-occluded retrograde transvenous obliteration was investigated. METHODS: Ten cirrhotic patients considered to have high risk gastric fundal varices underwent angiography. Six patients showed a communication between blood flow in gastric wall vessels and that in the gastrorenal shunt (type I), whereas the others (type II) did not. Depending on the flow direction in the left gastric vein, the two groups were further divided into hepatopetal (a) and hepatofugal (b) subgroups. The therapeutic effect on portal hemodynamics and the relationship between pretreatment portal hemodynamics and posttreatment occurrence of esophageal varices were investigated. RESULTS: Fundal varices disappeared endoscopically in all 10 patients and the gastrorenal shunt was also occluded after the procedure. No patient showed worsening of liver function or systemic complications during follow-up. The increase in portal blood flow was more significant in type Ib patients than in the others. Esophageal varices occurred in all type I patients, and as to those in type Ib, high risk varices developed within 6 months after treatment. On the other hand, esophageal varices did not occur in type II patients. CONCLUSIONS: This procedure was effective for treating gastric fundal varices. However, type Ib patients are likely to develop high risk esophageal varices after occlusion of the gastrorenal shunt.     

Demonstration of two distinct subsets of gastric varices

Over a seven-year period, assessment of gastric varices was made on 225 patients receiving endoscopic sclerotherapy for variceal hemorrhage. Of 170 patients with complete data, gastric varices were observed in 26 (15.3%). Importantly, two distinct subsets of gastric varices were identified: varices distal to the gastroesophageal junction without extension into the fundus, termed "junctional varices," occurred in 11.2%, and varices that were confined only to the fundus, termed "fundal varices," occurred less frequently in 4.1%. Although rebleeding was increased in both subsets of gastric varices, junctional varices were more amenable to sclerotherapy. Patients with fundal varices (N = 7) had a significantly higher rebleeding rate, increased complications with sclerotherapy, and significantly decreased survival (P less than 0.005) when compared to patients with esophageal varices alone (N = 87) who were followed for more than three months. Cumulative survival was not significantly different (P less than 0.08) in patients with junctional varices (N = 19) when compared with patients with esophageal varices alone. We conclude that not all patients with gastric varices have a poor result with sclerotherapy. Recognition of these subsets may improve treatment strategies in patients with gastric varices.     

Prophylactic transileocolic obliteration of esophageal varices after balloon-occluded retrograde transvenous obliteration of gastric varices with a gastrorenal shunt

Several non-surgical techniques have been developed to treat esophagogastric varices that occur secondary to portal hypertension, including those performed endoscopically or with interventional radiologic therapies. In patients with large gastric fundal varices and associated gastrorenal shunting, controversy still remains in defining the most appropriate non-surgical intervention. Balloon-occluded retrograde transvenous obliteration has been shown to be one effective treatment for gastric varices in these instances. However, in the population treated in this manner, the inhibition of subsequent esophageal varices is essential. We report a patient with gastric fundal varices that were successfully treated using balloon-occluded retrograde transvenous obliteration and in whom prophylactic transileocolic obliteration of esophageal varices was additionally performed. This 46-year-old man was diagnosed with severe gastric varices and gastrorenal shunting with only mild esophageal varices. Five years after therapy, the patient demonstrates no evidence of recurrence of either gastric or esophageal varices and has remained otherwise healthy.     

Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration

Although less common than oesophageal varices in portal hypertension, gastric fundal varices carry a higher mortality rate when they rupture. They are less amenable to sclerotherapy. We have developed a minimally invasive balloon-occluded retrograde transverse obliteration (B-RTO) procedure to treat gastric fundal varices. B-RTO involves inserting a balloon catheter into an outflow shunt (gastric-renal or gastric-vena caval inferior) via the femoral or internal jugular vein. Blood flow is then blocked by inflating the balloon, and 5% ethanolamine oleate iopamidol is injected in a retrograde manner. The embolized gastric varix subsequentlyl disappears. B-RTO was performed in 32 patients with gastric varices. Follow-up endoscopies were performed at intervals of 2–4 months for an average observation period of 14 months. Eradication of the varices has been confirmed in 31 of 32 patients. No recurrence occurred in any patients in the follow-up period. There were no significant changes in liver function after the procedure. We conclude that B-RTO is a safe and effective procedure for the treatment of gastric fundal varices.     

The treatment of gastric fundal varices--endoscopic therapy versus interventional radiology

BACKGROUND/AIMS: Balloon-occluded retrograde transvenous obliteration is an effective method for treating gastric fundal varices. The present retrospective study was performed to determine the clinical efficacy for gastric fundal varices associated with endoscopic therapy, surgery, and interventional radiology including balloon-occluded retrograde transvenous obliteration. METHODOLOGY: We classified 26 patients to a surgery group, an endoscopic therapy group, and an interventional radiology group according to initial treatment and subsequent treatment, and we compared the rates of hemostasis, eradication, and bleeding in these groups. RESULTS: Interventional radiology was successful in arresting acute hemorrhage in 100% of cases, while endoscopic therapy was successful in only 50% of cases. The rate of eradication was 100% in the Surgery group, 66.7% in the Endoscopic Therapy group, and 50% in the Interventional Radiology group. The cumulative bleeding rate at 5 years was 0% in the Surgery group, 0% in the Endoscopic therapy group, and 11.1% in the Interventional Radiology group. No significant difference was observed between the three groups. CONCLUSIONS: The treatment-of-choice for gastric fundal variceal hemorrhage is endoscopic injection sclerotherapy and ligation, with interventional radiology as the back-up procedure in case endoscopic injection sclerotherapy and ligation is unsuccessful. Interventional radiology is the treatment-of-choice for elective treatment of gastric fundal varices.     

Endoscopic sclerotherapy in the management of gastric variceal haemorrhage.

The value of injection sclerotherapy in the management of active gastric variceal bleeding is unclear. A retrospective study was therefore performed of 46 episodes of acute variceal haemorrhage in 41 patients who were treated by endoscopic sclerotherapy. The site of gastric variceal haemorrhage was the lesser curve (Group 1) in 13, within a hiatus hernia (Group 2) in six, and fundal with or without associated oesophageal varices (Type 3) in 22 cases. Haemostasis was achieved by sclerotherapy in 54%, 71.4% and 26%, respectively. After additional measures including balloon tamponade or surgery 85% of the Group 1 cases had stopped bleeding significantly more frequently than was observed in Group 3 (44.4%). More patients in Group 3 died due to uncontrolled bleeding (41%) than in Group I (7.7%). Hospital mortality depended on the severity of the liver disease with 15% of Child's grade A and 56% of grade C cases dying. It is concluded that endoscopic sclerotherapy of gastric varices should be reserved only for lesser curve or hiatal varices and that early surgery (or sclerotherapy using tissue adhesive) be considered for variceal haemorrhage originating from fundal varices.     

Detection of submucosal gastric fundal varices with multi-detector row CT angiography

BACKGROUND AND AIM: The diagnosis of submucosal fundal varices is challenging. Currently, endoscopy and endoscopic ultrasound (EUS) are considered most useful for this purpose. The aim of this study was to evaluate if multi-detector row CT (MDCT) angiography contributes to the diagnosis of submucosal fundal varices. PATIENTS AND METHODS: Twenty two patients with endoscopically suspected fundal varices were prospectively included in the study. All patients underwent EUS and MDCT angiography. Levels of agreement between EUS and MDCT angiography for the detection of submucosal and perigastric fundal varices were evaluated by three blinded independent readers. In addition, variceal size and location, as well as afferent and efferent vessels of the submucosal varices, were determined. RESULTS: Good or excellent image quality of MDCT angiography was obtained in 21/22 patients (95%). Based on EUS, submucosal varices were detected in 16 of 22 patients (73%) and perigastric varices in 22/22 patients (100%). Using MDCT angiography, the presence of submucosal varices was confirmed in all of these 16 patients by all three readers. Perigastric varices were also confirmed in all 22 patients by all three readers. In addition, all three readers noted the presence of a submucosal varix in an additional patient which was not detected on initial EUS. MDCT angiography showed an excellent interobserver reliability with regard to variceal diameter (kappa=0.90) and variceal location (kappa=0.94). Based on MDCT angiography, afferent and efferent vessels of submucosal varices included the left gastric vein in 11 (65%), the posterior/short gastric veins in 15 (88%), gastrorenal shunts in 10 (59%), the left inferior phrenic vein in six (35%), and the left pericardiophrenic vein in six (35%) of 17 patients. CONCLUSIONS: MDCT angiography is equivalent to EUS in terms of detection and characterisation of fundal varices, in particular with regard to the distinction between submucosal and perigastric fundal varices.     

内镜下套扎和组织胶注射分别治疗食管和胃底静脉曲张患者的临床观察

目的 探讨内镜下套扎和组织胶注射治疗食管胃底静脉曲张的疗效和价值.方法 予184例重度食管静脉曲张患者内镜下套扎治疗,其中32例伴胃底静脉曲张者还进行内镜下组织胶注射治疗.随访6个月并观察内镜下套扎和组织胶注射治疗的疗效和并发症.结果 内镜下套扎治疗重度食管静脉曲张的有效率为71.74％(132/184),急诊止血率为95.00％(57/60),并发症(食管套扎部位瘢痕狭窄需行扩张治疗)发生率为2.17％(4/184).内镜下组织胶注射治疗胃底静脉曲张的有效率为100％(32/32),并发症(注射部位难治性溃疡7例,其中难治性溃疡并出血2例)发生率为21.88％(7/32).均无穿孔、重度感染并发症发生.结论 内镜下套扎和组织胶注射治疗食管和胃底静脉曲张疗效良好.