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。     

内镜下尼龙圈辅助组织胶注射治疗胃静脉曲张伴胃肾分流的临床研究

目的 探讨创新性应用内镜下尼龙圈辅助组织胶注射治疗胃静脉曲张伴胃肾分流的安全性和疗效.方法 回顾性分析首都医科大学附属北京地坛医院2017年6月至2020年6月行内镜下尼龙圈辅助组织胶注射治疗的8例胃静脉曲张伴胃肾分流患者的临床资料,分析内镜下治疗前及内镜下治疗后10 d肝功能、肾功能、血细胞的变化,观察内镜下即时止血...     

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...     

脾肾或胃肾分流型静脉曲张的临床特征与处置

在诸如肝硬化等病因所导致的门静脉高压进程中,不仅可以引起常见的侧支循环形成,如食管胃静脉曲张,还可导致脾肾分流、胃肾分流等自发性门体分流通道的开放。有研究表明,大部分胃底静脉曲张患者存在不同程度的自发性门体分流,这类患者在临床特征、预后和治疗选择上都与无自发性门体分流患者有着显著区别,因此有必要对此类患者给予特别关注。     

内镜下注射聚桂醇与组织胶治疗肝硬化食管胃底静脉曲张的近远期疗效比较

目的探讨内镜下注射聚桂醇与组织胶治疗肝硬化食管胃底静脉曲张的近远期疗效。方法回顾性分析2013年4月至2014年4月四川达州市中心医院消化科确诊GV患者64例,随机分为研究组(n=32)和对照组(n=32),研究组采用聚桂醇与组织黏合剂于内镜下治疗,对照组采用单纯组织胶联合内镜治疗,分别于1、3、6个月复查胃镜,观察治疗前后静脉曲张的缓解情况,组织胶排出情况和局部增生状况,分析再出血发生率、静脉曲张治疗有效率与并发症。结果治疗后1个月研究组食管胃底静脉曲张总有效率为93.75%,对照组为90.62%,组间比较无明显差异(P0.05);而治疗后3个月和治疗后6个月研究组总有效率为93.75%和84.37%,对照组分别为71.87%和56.25%,组间比较具有显著性的差异(P0.05)。两组患者近期再出血率比较差异无显著性意义(P0.05);两组在止血成功率、远期再出血率、静脉曲张治疗有效率以及并发症发生率方面比较存在显著性差异(P0.05)。研究组患者经过治疗后,食管、胃底静脉曲张改善显著,对照组患者改善效果不明显或加重,组间比较具有显著性的差异(P0.05)。结论内镜下注射聚桂醇与组织胶治疗肝硬化食管胃底静脉曲张疗效确切,具有止血成功率高,静脉曲张改善显著,降低远期再出血及并发症的发生率,从而有助于患者预后恢复,值得推广应用。     

内镜下注射组织黏合剂治疗胃底静脉曲张破裂出血42例

[目的]观察内镜下注射组织黏合剂治疗胃底静脉曲张破裂出血的疗效.[方法]对42例胃底静脉曲张破裂出血患者进行内镜下注射组织黏合剂治疗.[结果]所有患者均一次成功止血,注射2周后内镜复查见固化组织黏合剂开始排出,随访3个月,无再出血及及死亡病例发生.[结论]内镜下注射组织黏合剂治疗胃底静脉曲张破裂出血是行之有效、快速的镜下止血方法,其操作简单,患者痛苦小,并发症少.     

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.     

经内镜注射组织黏合剂D-TH胶治疗胃静脉曲张出血的探讨

目的 探讨组织黏合剂D-TH胶治疗胃静脉曲张(GV)出血的价值。方法 内镜下用三明治夹心法注射D-TH胶治疗GV 59例,46例GV出血,其中37例急性出血,9例近期出血;13例无GV出血史。随访观察其疗效及并发症。结果 59例患者共注射96次,平均1.63次／例,每点注射1ml。37例GV急性出血患者,急诊止血率为100％,30例(65.2％)随访12-36个月,平均(24.9±11.7)个月,3个月再出血率6.7％(2／30),12个月再出血率16.7％(5／30),36个月再出血8例,生存率为86.5％。术后发热2例,无其他并发症发生。结论 经内镜注射D-TH胶治疗GV出血是一种安全、有效的方法。     

内镜超声引导弹簧圈栓塞联合内镜组织胶注射治疗胃底静脉曲张的回顾性研究

目的　评价内镜超声（endoscopic ultrasound,EUS）引导弹簧圈栓塞联合内镜组织胶注射治疗合并较大自发性分流道的胃底静脉曲张的疗效和安全性。方法　回顾性分析武汉大学人民医院2016年12月—2020年12月因胃底静脉曲张伴较大自发性分流道（分流道最窄处直径5~15 mm）接受EUS引导弹簧圈栓塞联合内镜组织胶注射的24例患者资料,统计并分析短期疗效（技术成功率、术后5 d再出血率、6周死亡率）、远期疗效（1年再出血率和死亡率、3年死亡率）及安全性（异位栓塞发生率）。结果　EUS引导弹簧圈栓塞联合内镜组织胶注射技术成功率91.7%（22/24）,5 d再出血率0（0/22）。1例（4.5%）术后2 d复查门静脉系统血管CT成像显示脾静脉主干部分栓塞。22例患者中2例失访,随访时间14.9（1.0~48.6）个月,术后6周死亡率0（0/20）,术后1年再出血率35.0%（7/20）。12例行胃镜随访的患者中,5例出现不同程度食管静脉曲张加重,5例出现不同程度门静脉高压性胃病加重。术后1年死亡率5.0%（1/20）,术后3年死亡率20.0%（4/20）,均与出血及异位栓塞事件无关。结论　对于合并较大自发性分流道的胃底静脉曲张患者,EUS引导弹簧圈栓塞联合内镜组织胶注射治疗短期安全有效,并能降低异位栓塞发生风险,远期疗效及安全性仍有待进一步证实。     

钛夹辅助下内镜组织胶注射治疗胃静脉曲张

目的初步探讨钛夹辅助内镜下组织胶注射治疗胃静脉曲张的安全性、有效性及操作注意事项。 方法回顾性分析2018年1月至2019年7月山东省立医院东院消化科行钛夹辅助下内镜组织胶注射治疗胃静脉曲张患者10例,经胃镜证实为GOV2型或IGV1型胃静脉曲张,术前强化CT及CTA显示均存在明显胃肾分流道。先在胃镜下观察胃曲张静脉团的供血或回流血管分支、并行钛夹夹闭,以减缓或阻断胃曲张静脉内血液流速,后再胃镜下行组织胶注射,以预防组织胶的异位栓塞。分析10例患者的操作成功率、静脉曲张消失、术后再出血率、并发症等情况。 结果纳入的10例患者均成功进行钛夹辅助下内镜组织胶注射治疗,随访时间39～157 d ,平均随访85.7 d。术后强化CT复查显示10例患者胃静脉曲张均基本消失或明显减轻。术后有1例患者发生排胶溃疡再出血,未出现异位栓塞相关的症状和体征,未出现其他明显并发症。 结论钛夹辅助下内镜组织胶注射操作简便、安全,是合并胃肾分流的胃静脉曲张治疗的有效方式,值得进一步临床研究。     

应用正丁基-2-氰丙烯酸盐经门静脉硬化治疗胃底静脉曲张

目的 探讨应用正丁基-2-氰丙烯酸盐(NBCA)经门静脉硬化治疗胃底静脉曲张(GFV)的临床疗效及安全性. 方法经胃镜确诊为GFV的21例门静脉高压症患者接受了经门静脉硬化治疗,所有患者采取经皮经肝或经脾穿刺门静脉造影及供血静脉造影,然后用微导管插管到曲张静脉内,注入硬化剂NBCA和碘化油混合乳剂(NBCA LP).对8例伴有高流量胃肾分流者,治疗前经股静脉、左肾静脉放置阻塞球囊导管于分流道,治疗时扩张球囊阻塞分流道.随访评价包括血清肝功能指标变化、内镜复查及再出血情况. 结果 20例GFV成功进行硬化治疗(95.2%);未成功的1例,为高流量胃肾分流者,术中因未有阻塞球囊导管,未能进行治疗.5例少量NBCA-LP进入到肺动脉,2例出现一过性刺激性咳嗽,2例发生门静脉分支栓塞.术后6个月,血清ALT、白蛋白、凝血酶原时间明显改善,血清总胆红素变化不明显.15例患者3个月胃镜复查,GFV消失10例,好转4例,有效率93.3%(14/15),3例食管静脉曲张较术前加重(20.0%).平均随访(16.7±8.8)个月,再出血4例,1年累积再出血率为9.52%.结论 应用NBCA经门静脉硬化治疗是控制GFV破裂出血的安全有效方法,微导管技术、球囊逆行阻塞胃肾分流道技术是提高疗效、防止肺栓塞的关键.     

N-butyl-2-cyanoacrylate,iso-amyl-2-cyanoacrylate and hypertonic glucose with 72% chromated glycerin in gastric varices

AIM: To compare n-butyl-2-cyanoacrylate, iso-amyl-2-cyanoacrylate and a mixture of 72% chromated glycerin with hypertonic glucose solution in management of gastric varices. METHODS: Ninety patients with gastric varices presented to Endoscopy Unit of Ain Shams University Hospital were included. They were randomly allocated into three groups; each group included 30 patients treated with intravariceal sclerosant injections in biweekly sessions till complete obturation of gastric varices; Group I(n-butyl-2-cyanoacrylate; Histoacryl), Group II(iso-amyl-2-cyanoacrylate; Amcrylate) and Group III(mixture of 72% chromated glycerin; Scleremo with glucose solution 25%). All the procedures were performed electively without active bleeding. Recruited patients were followed up for 3 mo. RESULTS: 26% of Scleremo group had bleeding during puncture vs 3.3% in each of the other two groups with significant difference,(P 0.05). None of Scleremo group had needle obstruction vs 13.3% in each of the other two groups with no significant difference,(P 0.05). Rebleeding occurred in 13.3% of Histoacryl and Amcrylate groups vs 0% in Scleremo group with no significant difference. The in hospital mortality was 6.6% in both Histoacryl and Amcrylate groups, while it was 0% in Scleremo group with no significant difference. In the first and second sessions, the amount of Scleremo needed for obturation was significantly high, while the amount of Histoacryl was significantly low. Scleremo was the less costly of the two treatments. CONCLUSION: All used sclerosant substances showed efficacy and success in management of gastric varices with no significant differences except in total amount, cost and bleeding during puncture.     

Study of glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding

AIM: To investigate glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding and to evaluate the long-term efficacy and safety of this therapy.METHODS: A total of 148 cirrhotic patients in our hospital with esophagogastric variceal bleeding (EGVB) were included in this study. N-butyl-2-cyanoacrylate was mixed with lipiodol in a 1:1 ratio and injected as a bolus of 1-3 mL according to variceal size. Patients underwent endoscopic follow-up the next week, fourth week, second month, fourth month, and seventh month after injection and then every 6 mo to determine the cast shape. An abdominal X-ray film and ultrasound or computed tomographic scan were also carried out in order to evaluate the time of variceal disappearance and complete extrusion of the cast. The average follow-up time was 13.1 mo.RESULTS: The instantaneous hemostatic rate was 96.2%. Early re-bleeding after injection in 9 cases (6.2%) was estimated from rejection of adhesive. Late re-bleeding occurred in 12 patients (8.1%) at 2-18 mo. The glue cast was extruded into the lumen within one month in 86.1% of patients and eliminated within one year. Light erosion was seen at the injection position and mucosa edema in the second week. The glue casts were extruded in 18 patients (12.1%) after one week and in 64 patients (42.8%) after two weeks. All kinds of glue clumping shapes and colors on endoscopic examination were observed in 127 patients (86.1%) within one month, including punctiform, globular, pillar and variform. Forty one patients (27.9%) had glue extrusion after 3 mo and 28 patients (28.9%) after six months. The extrusion time was not related to the injection volume of histoacryl. Obliteration was seen in 70.2% (104 cases) endoscopically. The main complication was re-bleeding resulting from extrusion. The prognosis of the patients depended on the severity of the underlying liver disease.CONCLUSION: Endoscopic injection of cyanoacrylate is highly effective for gastric varices bleeding. The glue clump shape is correlated with anatomic structure of vessels. The time of extrusion was not related to dosage of the glue.     

Treatment of patients with gastric variceal hemorrhage: Endoscopic N-butyl-2-cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration

Background and Aim:  Our study aimed to evaluate the therapeutic results of endoscopic N-butyl-2-cyanoacrylate injection (EBC) and balloon-occluded retrograde transvenous obliteration (BRTO) in patients with gastric variceal hemorrhage (GVH) and/or high-risk gastric varices (GV).
Methods:  Twenty-seven patients with GVH and/or high-risk GV (≥ 5 mm in diameter, those with red spots, and a Child–Pugh grading of B or C liver cirrhosis) who were treated with either EBC or BRTO from April 2005 to December 2007 were included in our study.
Results:  EBC or BRTO was initially used for the treatment of GVH in 14 and 13 patients, respectively. Technical success was achieved in all 14 patients (100%) initially treated with EBC, and 10 of 13 patients (76.9%) initially treated with BRTO. Significant rebleeding occurred in 10 patients (71.4%) of the EBC group, and two patients (15.4%) of BRTO group ( P  < 0.01). Five of six patients (83.3%) treated with rescue BRTO due to rebleeding after initial EBC achieved technical success, and all six patients who were treated with rescue BRTO had no rebleeding during the median follow up of 17 (range: 2–37) months. The cumulative survival rate of the EBC with the BRTO rescue group/BRTO group was significantly higher than the EBC group.
Conclusion:  The therapeutic efficacies of EBC and BRTO for the treatment of active GVH and/or high-risk GV appeared to be similar. However, EBC might be associated with a higher rebleeding rate than BRTO. BRTO could be an effective rescue treatment for patients with GVH after initial treatment of EBC.     

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。     

Management of gastric fundal varices without gastro-renal shunt in 15 patients

AIM： To examine the portal hemodynamics of gastric fundal varices （GV） without gastro-renal shunt （GRS）, and to retrospectively investigate the effects of various kinds of treatment on eradication. METHODS： Ninety-four liver cirrhosis patients at high-risk of GV were treated in our hospital and enrolled in this study. We retrospectively examined their characteristics, liver function, and portal hemodynamics of GV. We performed balloon-occluded retrograde transvenous obliteration （BRTO） at first. If it was not technically possible to perform BRTO, endoscopic injection sclerotherapy using α-cyanoacrylate glue （CA） or percutaneous transhepatic obliteration （PTO） was performed. RESULTS： Among the 94 patients, a GRS was present in 79 （84.0%）, and absent in the remaining 15 （16.0%）. The subphrenic vein was connected to the inferior vena cava as the drainage vein in 13 （86.7%） out of the 15 cases without GRS. We performed BRTO in 6 patients, CA in 4 patients and PTO in 5 patients. The eradication rate was 100% for each procedure, but the rate of early recurrence within 6 mo was 16.7% for BRTO, 50.0% for CA and 40.0% for PTO, respectively. CONCLUSION： We should examine the hemodynamics before treatment of GV irrespective of the existence of GRS. If this hemodynamic examination reveals that the drainage vein connects directly to the inferior vena cava in GV without GRS, BRTO may be an effective treatment for GV with GRS.     

Cerebral and splenic infarctions after injection of N-butyl-2-cyanoacrylate in esophageal variceal bleeding

Variceal bleeding is the most serious complication of portal hypertension,and it accounts for approximately one fifth to one third of all deaths in liver cirrhosis patients.Currently,endoscopic treatment remains the predominant method for the prevention and treatment of variceal bleeding.Endoscopic treatments include band ligation and injection sclerotherapy.Injection sclerotherapy with N-butyl-2-cyanoacrylate has been successfully used to treat variceal bleeding.Although injection sclerotherapy with N-butyl-2-cyanoacrylate provides effective treatment for variceal bleeding,injection of N-butyl-2-cyanoacrylate is associated with a variety of complications,including systemic embolization.Herein,we report a case of cerebral and splenic infarctions after the injection of N-butyl-2-cyanoacrylate to treat esophageal variceal bleeding.     

Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding

AIM: To study the prevalence, predictors and control of bleeding following N-butyl 2 cyanoacrylate (NBC) sclerotherapy of gastric varix (GV). METHODS: We analyzed case records of 1436 patients with portal hypertension, who underwent endoscopy during the past five years for variceal screening or upper gastrointestinal (GI) bleeding. Fifty patients with bleeding GV underwent sclerotherapy with a mean of 2 mL NBC for control of bleeding. Outcome parameters were primary hemostasis (bleeding control within the first 48 h), recurrent bleeding (after 48 h of esophago- gastro-duodenoscopy) and in-hospital mortality were analyzed. RESULTS: The prevalence of GV in patients with portal hypertension was 15% (220/1436) and the incidence of bleeding was 22.7% (50/220). Out of the 50 bleeding GV patients, isolated gastric varices (IGV-I) were seen in 22 (44%), gastro-oesophageal varices (GOV) on lesser curvature (GOV-Ⅰ) in 16 (32%), and GOV on greater curvature (GOV-Ⅱ) in 15 (30%). IGV-Ⅰ was seen in 44% (22/50) patients who had bleeding as compared to 23% (39/170) who did not have bleeding (P < 0.003). Primary hemostasis was achieved with NBC in all patients. Re-bleeding occurred in 7 (14%) patients after 48 h of initial sclerotherapy. Secondary hemostasis was achieved with repeat NBC sclerotherapy in 4/7 (57%). Three patients died after repeat sclerotherapy, one during transjugular intrahepatic portosystemic stem shunt (TIPSS), one during surgery and one due to uncontrolled bleeding. Treatment failure-related mortality rate was 6% (3/50). CONCLUSION: GV can be seen in 15% of patients withportal hypertension and the incidence of bleeding is 22.7%. NBC is highly effective in controlling GV bleeding. In hospital mortality of patients with bleeding GV is 6%.     

Long-term result of endoscopic Histoacryl （N-butyl-2-cyanoacrylate）injection for treatment of gastric varices

AIM: To evaluate the long-term efficacy and safety of endoscopic obliteration with Histoacryl^® for treatment of gastric variceal bleeding and prophylaxis.METHODS: Between January 1994 and March 2010 at SoonChunHyang University Hospital, a total of 127 patients with gastric varices received Histoacryl^® injections endoscopically. One hundred patients underwent endoscopic Histoacryl^® injections because of variceal bleeding, the other 27 patients received such injections as a prophylactic procedure.RESULTS: According to Sarin classification, 56 patients were GOV1, 61 patients were GOV2 and 10 patients were IGV. Most of the varices were large (F2 or F3, 111 patients). The average volume of Histoacryl^® per each session was 1.7 ± 1.3 cc and mean number of sessions was 1.3 ± 0.6. (1 session-98 patients, 2 sessions-25 patients, ≥ 3 sessions-4 patients). Twenty-seven patients with high risk of bleeding (large or fundal or RCS+ or Child C) received Histoacryl^® injection as a primary prophylactic procedure. In these patients, hepatitis B virus was the major etiology of cirrhosis, 25 patients showed GOV1 or 2 (92.6%) and F2 or F3 accounted for 88.9% (n = 24). The rate of initial hemostasis was 98.4% and recurrent bleeding within one year occurred in 18.1% of patients. Successful hemostasis during episodes of rebleeding was achieved in 73.9% of cases. Median survival was 50 mo (95% CI 30.5-69.5). Major complications occurred in 4 patients (3.1%). The rebleeding rate in patients with hepatocellular carcinoma or GOV2 was higher than in those with other conditions. None of the 27 subjects who were treated prophylactically experienced treatment-related complications. Cumulative survival rates of the 127 patients at 6 mo, 1, 3, and 5 years were 92.1%, 84.2%, 64.2%, and 45.3%, respectively. The 6 mo cumulative survival rate of the 27 patients treated prophylactically was 75%.CONCLUSION: Histoacryl^® injection therapy is an effective treatment for gastric varices and also an effective prophylactic treatment of gastric varices which carry high risk of bleeding.     

胃镜下聚桂醇注射治疗肝硬化并发食管静脉曲张患者临床疗效研究

目的 探讨在胃内镜下聚桂醇注射治疗肝硬化并发食管静脉曲张患者的临床疗效及安全性。方法 2016年1月~2017年12月在我院行内镜下硬化治疗的肝硬化并发食管静脉曲张患者80例,其中38例接受内镜下注射聚桂醇治疗,另42例接受内镜下注射鱼肝油酸钠治疗,随访12个月。结果 注射聚桂醇组显效和有效率分别为65.8%和26.3%,与注射鱼肝油酸钠组的69.0%和26.2%比,差异无统计学意义（P>0.05）;注射聚桂醇组急诊止血成功率和再出血发生率分别为92.1%和34.2%,与注射鱼肝油酸钠组的95.2%和31.0%比,差异均无统计学意义（P>0.05）;注射聚桂醇组术后发热、胸痛、溃疡和食管狭窄发生率分别为13.2%、13.2%、10.5%和2.6%,均明显低于注射鱼肝油酸钠组（分别为33.3%、38.1%、42.9%和19.1%,P<0.05）;在随访3个月、6个月和12个月时,注射聚桂醇组曲张静脉复发率分别为10.53%、18.42%和28.95%,与注射鱼肝油酸钠组的9.52%、14.29%和30.95%比差异无统计学意义（P>0.05）。结论 在胃内镜下注射聚桂醇治疗肝硬化并发食管静脉曲张患者止血成功率高,疗效确切,且术后并发症发生率较低,是一种安全有效的治疗方法。