内镜下胃底静脉曲张结扎治疗

目的 研究结扎法治疗胃底静脉曲张的疗效和并发症发生情况。方法 31例胃底静脉曲张患者，其中食管静脉曲张合并胃底静脉曲张23例，单纯胃底静脉曲张8例，年龄32-63岁，其中男24例，女7例，结扎器采用连发结扎器（Wilson-Cook公司产品）和气动单发结扎器（日本秋田公司产品），结扎个数为4-12个，结果 14例胃底静脉曲张经过1次治疗后消失，16例经过2-4次结扎后消失，1例经过4次治疗后效差改为手术治疗，5例活动性出血均得到控制，术后2周内再出血3例（9.7%)，1月内再出血5/31例（16%），1例因再发大出血死亡，1例死于自发性腹膜炎。结论 （1）结扎术是一有效的胃底静脉曲张治疗方法，其单次结扎后静脉曲张消失率（45%）优于食管静脉曲张（17%）。（2）并发症与食管曲张静脉结扎术相似。（3）气动结扎器用于胃底静脉结扎，橡皮圈释放可靠性优于连发结扎器。

Endoscopic management of gastric varices with rubber ligation.

Objective To study gastric variceal ligation for the management of different types of gastric varices.Methods Gastric variceal ligation was performed in 31 patients with gastric varices in West China Hospital of these patients 15 had type 1 gastroesophageal varices,8 had type 2, 8 had isolated gastric varices.The etiology of portal hypertension was hepatic cirrhosis in 27 patients,hepatic cirrhosis mixed with hepatic cancer in 3,and pancreatic cancer in 1 patient.The Child Pugh classification was grade A in 2, B in 12,and C in 17 cases.Active variceal bleeding was present in 5 patients;all cases had a history of variceal bleeding once at the least.Results Emergency gastric variceal ligation arrested bleeding in all 5 patients.Recurrent bleeding was noted in 5 of 31 (16%).Two patients died,one died of recurrent bleeding and the other of peritonitis with liver failure.. Variceal obliteration was achieved in all patients who underwent repeated elective sessions.Compared with esophageal varices,the number of sessions needed for obliteration of varices was less in gastric varices.Conclusion Gastric variceal ligation is a safe and effective treatment for gastric varices.