内镜下注射与钛夹联合治疗食管贲门黏膜撕裂综合征出血的临床研究

目的探讨内镜下金属钛夹与注射联合应用在食管贲门黏膜撕裂综合征出血患者中的治疗价值。方法对我科2005年1月~2010年1月所诊治的83例食管贲门黏膜撕裂综合征（MWS）出血患者进行随机分组,A组行内镜下注射＋金属钛夹治疗,B组单纯行内镜下金属钛夹治疗。分析两组治疗时间、止血效果和再出血等方面的差异。结果 A组患者平均治疗时间12.6 min;B组患者平均治疗时间15.2 min。83例患者经两种方法治疗后,均可立即止血。A组无再次出血患者,B组2例患者再出血。结论内镜下注射＋金属钛夹联合治疗食管贲门黏膜撕裂出血具有止血效果确实可靠、定位准确和操作简便等优点,可作为食管贲门黏膜裂出血的首选治疗。     

金属钛夹治疗贲门黏膜撕裂出血12例分析

1998年以来我院采用经胃镜金属钛夹治疗贲门黏膜撕裂症,成功治愈了12例。 1.病例选择:本组患者共12例均男性,年龄41～68岁,所有患者均有24 h内大量呕血(呕血量在1 500 ml以上),其中伴休克9例。发病前有大量饮酒史8例,有不同程度的     

食管贲门黏膜撕裂综合征28例

2003年12月-2005年12月我院经胃镜诊断食管贲门撕裂综合征28例，占同期5420例次胃镜检查的0．52％，占同期上消化道出血病例的1．5％，现报告如下。     

胃镜下钛夹夹闭止血治疗贲门黏膜撕裂症28例疗效观察

2002年1月～2005年12月，我们采用胃镜下钛夹治疗贲门黏膜撕裂症患者28例。现报告如下。     

食管-贲门黏膜撕裂综合征临床分析78例

目的:探讨食管.贲门黏膜撕裂综合征(MalloryWeiss syndrome,MWS)的临床特点、内镜下表现和治疗.方法:对2003-03/2008-04收治的78例MWS患者的临床资料进行回顾性分析.结果:MWS占上消化道出血的6.13%,饮酒后呕吐是其主要发病原因.内镜下均为线状纵行撕裂,以贲门撕裂多见,裂伤表面状态与发病至行胃镜检查的时间有关(P＜0.05),与Hpylod感染和患者年龄无关.78例MWS患者8例给予内镜下止血治疗后均无再出血.70例给予保守治疗,仅1例复发出血,给予内镜下止血治疗后出血停止.结论:MWS保守治疗和内镜下止血治疗均取得较好疗效,对保守治疗无效者可考虑内镜下止血治疗.     

球囊压迫辅助下内镜硬化剂注射术治疗食管静脉曲张的随机对照研究

目的　探讨球囊压迫辅助下内镜硬化剂注射术（balloon compression?assised endoscopic injection sclerotherapy,bc?EIS）治疗肝硬化食管静脉曲张的临床疗效及安全性。方法　2020年12月—2021年4月,在安徽医科大学第一附属医院消化内科拟行内镜下治疗的肝硬化食管静脉曲张患者作为研究对象,采用计算机随机法随机分入试验组（接受bc?EIS治疗）或对照组（接受内镜下静脉曲张套扎术治疗）,主要观察2组的曲张静脉根除率、再出血率和术后不良反应情况。结果　研究期间经纳入标准初步纳入93例,经排除标准排除9例,最终纳入84例进行数据分析,每组42例。试验组1次治疗的食管曲张静脉根除率为88.10%（37/42）,明显高于对照组的33.33%（14/42）（χ2=26.40,P<0.001）;1~2次治疗的食管曲张静脉根除率为97.62%（41/42）,明显高于对照组的40.48%（17/42）（χ2=29.47,P<0.001）;1~3次治疗的食管曲张静脉根除率为100.00%（42/42）,明显高于对照组的45.24%（19/42）（P<0.001）。随访时间最长6个月,试验组无一例再出血,对照组再出血率为4.76%（2/42）（P=0.494）。试验组和对照组胸腹部不适发生率分别为26.19%（11/42）和35.71%（15/42）（χ2=0.51,P=0.474）;恶心呕吐发生率分别为2.38%（1/42）和7.14%（3/42）（χ2=0.26,P=0.608）;腹胀发生率分别为4.76%（2/42）和11.90%（5/42）（χ2=0.62,P=0.430）。2组均未发生感染、吞咽困难、穿孔、食管气管瘘管、食管狭窄、异位栓塞等其他不良事件。结论　bc?EIS治疗肝硬化食管静脉曲张疗效显著且安全,1次治疗食管曲张静脉根除率可达85%以上,经1~3次治疗后可全部根除。     

贲门粘膜撕裂综合征致大出血4例报道

我院近 10年来通过上消化道内镜检出食管贲门粘膜撕裂综合征 19例 ,其中伴大出血 4例 ,报道如下。临床资料一般资料　 4例均为住院患者 ,男 3例 ,女 1例 ;年龄 30～ 40岁 3例 ,6 0岁以上 1例。发病诱因 :2例为大量饮酒 ,1例为恶性肿瘤化疗反应 ,1例为食管癌放疗过程中因进食大块肉引起梗阻。主要症状 :4例出血前均有剧烈呕吐史 ,1例有剑突下刺痛。临床上均有呕血及黑便 ,出血量均在 10 0 0ｍｌ以上。患者有明显低血容量表现 ,主诉头昏、心悸、乏力 ,心率10 0～ 12 0次 /ｍｉｎ ,血压 70～ 90 / 45～ 5 6ｍｍＨｇ。内镜检查时间 :2例于出血后…     

食管-贲门黏膜撕裂综合征的诊治进展

随着人们生活方式和饮食结构的改变,食管-贲门黏膜撕裂综合征(MWS)的发病率逐年升高,其撕裂出血与其他上消化道出血一样可能危及生命。近年来研究表明,结合人体体型分析和内镜探查可提高MWS诊断率,采用GB评分(GlasgowBlatchford score)对其进行危险度分层,可指导临床治疗,对预测预后有一定的指导意义。该文就MWS的临床诊断方法、危险评估及治疗方法作一综述。     

经内镜钛夹治疗贲门粘膜撕裂症5例分析

目的 验证金属钛夹治疗贲门粘膜撕裂症伴出血临床应用价值。方法 选用奥林巴斯HX-5LR-1型钛夹置放操作器及HX-600-135型金属钛夹，在内镜直视下对准条状撕裂带两端置放钛夹，确认完全止血后结束治疗。结果 5例贲门粘膜撕裂症经金属钛夹钳夹止血治疗后均成功止血。结论 金属钛夹治疗贲门粘膜撕裂症是一种简单有效、止血效果显著，值得临床推广的一种治疗方法，并能使一部分病人免除手术治疗，     

硬化剂在肝硬化食管静脉曲张破裂出血防治中的优化应用

约50%的肝硬化患者初诊时即存在食管胃静脉曲张,尤以食管静脉曲张(EV)常见,且EV的发生率随肝脏疾病严重程度增加而增高(Child-Pugh A 43%、Child-Pugh B 71%、Child-Pugh C 76%)[1]。<5 mm的EV以每年10%的速度进展为大的EV,小EV的年出血率为5%,而大EV可达15%,EV出血后6周内死亡率高达20%[2-4]。急性EV破裂出血停止后再次出血率和死亡率较高,未进行二级预防的EV患者1~2年内再次出血率高达60%,死亡率高达33%[5]。因此EV破裂出血的防治非常重要,内镜干预在EV破裂出血的防治中起重要作用,包括内镜下静脉曲张套扎术(EVL)、内镜下硬化剂注射治疗(EIS)、自膨式金属支架等[5-6]。本文就EIS在EV破裂出血的防治作用做一述评。     

Successful endoscopic sclerotherapy for bleeding gastric varices with combined cyanoacrylate and aethoxysklerol

Two patients with liver cirrhosis and portal hyper-tension related to hepatitis infection were admitted to Shanghai Ruijin Hospital due to recurrent melena and hematemesis. Isolated gastric varices were observed in the gastric fundus during the retroflexion of gastroscope. We carried out endoscopic sclerotherapy successfully for bleeding gastric varices with combined cyanoacrylate and aethoxysklerol, which disappeared dramatically several months after two courses of sclerotherapy for each patient. No complication and clinical signs of gastrointestinal re-bleeding were observed during the 6-mo endoscopic follow-up. CT portal angiography （CTPA） has been widely used in the assessment of variceal treatment and improves the results of endoscopic injection therapy.     

普萘洛尔和经内镜硬化治疗预防肝硬化静脉曲张再出血的荟萃分析

目的:系统评价普萘洛尔和经内镜硬化疗法预防肝硬化静脉曲张再出血的有效性和安全性.方法:计算机检索PubMed、EMBASE、Cochrane Library、CBM、CNKI、VIP数据库2009-02前发表的有关普萘洛尔和经内镜硬化疗法预防肝硬化静脉曲张再出血的随机对照试验,2名评价员独立对纳入文献进行质量评价和数据提取,用RevMan5.0软件统计分析.结果:共纳入9篇随机对照试验共计740例患者,Meta分析结果显示:两组在生存率(RR=0.97,95%CI:0.86-1.10)、病死率(RR=1.20.95%CI:0.90-1.59)方面差异均无统计学意义;普萘洛尔组再出血率高于经内镜硬化治疗组(RR=1.33,95%CI:1.14-1.54),但普萘洛尔组不良反应发生率低(RR=0.48,95%CI:0.26-0.86).结论:普萘洛尔与经内镜硬化治疗在预防再出血,再出血发生率高但不良反应发生率低.     

Choledochal varices bleeding: A case report

Choledochal varices are a rare cause of hemobilia associated with chronic portal vein thrombosis. We present a case of chronic portal vein thrombosis complicated with bleeding from choledochal varices. The presentation, clinical manifestations and management are described.     

The value of the endoscopic therapies in the treatment of rectal varices: a retrospective comparison between injection sclerotherapy and band ligation.

This study consisted of 15 patients who had undergone endoscopic injection sclerotherapy (EIS) or endoscopic variceal ligation (EVL) for rectal varices. Ten of fifteen patients had histories of anal bleeding, and colonoscopy revealed signs of the risk of variceal rupture in the other five patients. EIS was perfomed in six of the fifteen patients, and the other nine patients underwent EVL. EIS was performed weekly from 2 to 4 times (mean, 3.0), and the total amount of sclerosant ranged from 3.2 to 5.8ml (mean, 4.9ml). After EIS, colonoscopy revealed shrinkage of the rectal varices in all six patients with no complications. EVL was performed weekly from 1 to 3 times (mean, 2.2), and bands were placed on the varices at 2-12 sites (mean, 8.0). After EVL, colonoscopy revealed both ulcers and shrinkage of the varices in the rectum in all nine patients. Eight of the nine experienced no operative complications. However, in the other case, colonoscopy revealed bleeding from ulcers after EVL. The average follow-up period after EIS or EVL was 30 months. The overall non-recurrence rate of rectal varices was 11 of 15 (73.3%); this includes five of the six patients (83.3%) receiving EIS and six of the nine who received EVL (66.7%). The non-recurrence rate was no difference between EIS group and EVL group statistically (P=0.57) by reason of small number of cases. In conclusion, EIS is some superior to EVL with regard to long-term effectiveness, complications on rectal varices.     

肝硬化继发小肠淋巴管扩张症1例

1．病例资料：患者男，32岁，因“乙型肝炎病史7年，腹胀1年加重伴纳差1周”于2007年1月入院。患者7年前无明显诱因出现全身乏力，经检查确诊为慢性乙型肝炎，未予重视；1年前因腹胀确诊为肝硬化并腹水入院治疗，腹水消失后出院。1周前患者自觉明显腹胀，食欲不振以肝硬化并腹水收入住院。患者此次发病以来体重无明显变化，大便1～2次／d，黄色软便，无腐臭味。[第一段]     

心得安单纯或联合使用在二级预防食管静脉曲张出血中的疗效比较

目的比较单纯心得安、套扎＋心得安、硬化剂＋心得安二级预防食管静脉曲张出血的疗效,探寻心得安二级预防食管静脉曲张出血的最佳组合。方法78例食管静脉曲张出血患者随机分成3组,每组26例,止血后分别给予心得安（心得安组）、套扎＋心得安（套扎组）、硬化剂＋心得安（硬化剂组）,比较各组12个月内再出血率、死亡率,以及各组门脉高压性胃病、胃底静脉曲张发生率、食管曲张静脉复发率。结果12个月内再出血率套扎组为30．77％,明显低于心得安组（53．85％）及硬化组（42．31％）（P均〈0．05）;套扎组和心得安组门脉高压性胃病及胃底静脉曲张发生率相似,都明显低于硬化组（P均〈0．05）;而食管静脉曲张再发率高于硬化组（P〈0．05）。结论在应用心得安的基础上进行套扎治疗可能是目前食管静脉曲张出血最有效的二级预防方法。     

Endoscopic management of gastric varices using a detachable snare and simultaneous endoscopic sclerotherapy and O-ring ligation

BACKGROUND: Cyanoacrylate injection is highly effective and is regarded as the treatment of choice in bleeding gastric varices in Europe, but intravenous injection of cyanoacrylate is not allowed in the USA and Japan because it may cause embolisms in other organs. Accordingly, we developed a new endoscopic combined treatment of endoscopic management of gastric varices using a detachable snare (EVLs) and simultaneous endoscopic sclerotherapy and O-ring ligation (EISL) (i.e. EVLs + EISL), and we prospectively evaluated its efficacy and safety. METHODS: Gastric varices were ligated with the loop of a detachable snare that opened to a diameter of 4 cm (EVLs). Then the residual varices around the ligated portion were sclerosed by ethanolamine oleate and the injected vessel was ligated using a pneumo-activated EVL device (EISL). The EVLs + EISL was performed in 35 patients: on an emergency basis in eight patients, on an elective basis in six patients and as primary prophylaxis in 21 patients. Liver function was classified as Child-Pugh class A in 12 patients, class B in 12 patients and class C in 11 patients. RESULTS: Endoscopic disappearance of gastric varices was obtained in 97.1% of the patients and they regressed in all patients. Haemostasis was achieved in all eight emergency cases. The 2-year cumulative non-recurrence rate was 85%, the 2-year cumulative non-bleeding rate was 92% and the 2-year cumulative survival was 80%. No patients died of bleeding from gastric varices. There were no serious short-term complications, such as haemorrhage, gastro-oesophageal perforation, ileus, or renal impairment. CONCLUSION: Combined EVLs + EISL appears to be a useful treatment for gastric varices due to its safety and good clinical outcome.