胃静脉曲张的治疗

关键内容●　胃静脉曲张 (GV)与食道静脉曲张 (EV)同为门脉高压症的严重并发症 ,其发病率约 2 %～ 10 0 % ;多出现在门脉高压病程的较晚期。肝硬化等原因引起全门静脉高压时 ,可发生EV和 /或GV ,而部分性门脉高压常因胰腺病变引起脾静脉栓塞所致 ,又称左侧门静脉高压症 ;仅有GV而无EV。●　诊断GV较困难 ,常用方法有X线钡餐检查、内镜检查、脾门静脉造影或经皮经肝门静脉造影 ,以及超声内镜等。内镜检查虽为主要方法 ,但其检出率不尽如人意。●　GV破裂出血时可首选生长抑素及其类似物奥曲肽、加压素及其类似物等药物治疗。●　双囊三腔管填塞压迫仍为有效的止血措施 ,但压迫时间不宜长 ;一般作为创造条件行介入治疗的权宜之计。●　内镜治疗包括硬化剂注射、组织胶注射及套扎治疗等。其中组织胶注射治疗不仅能控制急性活动性出血 ,还能使曲张静脉消失。此法宜作为治疗GV活动性出血的首选方法。●　根据具体情况 ,还可选用TIPS、脾动脉栓塞疗法、脾切除术、胃断流术及原位肝移植术等治疗GV。     

内镜下治疗食管胃底静脉曲张八例

内镜下治疗食管胃底静脉曲张八例文黎明赵世泉刘红专近来内镜下治疗食管静脉曲张（ＥＶ）报道较多，但同时进行胃底静脉曲张（ＶＦＳ）治疗尚少见报道，作者对８例食管胃底静脉曲张进行了联合治疗，现报告如下。１．对象和方法：本组男６例，女２例，年龄３３～６５岁，病...     

急诊内镜下套扎治疗胃静脉曲张出血

１９９４年５月始,我们采用内镜下曲张静脉套扎术治疗食管和／或胃静脉曲张出血（ＧＶ）患者,其中１３例ＧＶ出血患者套扎治疗取得了较好的疗效,现将结果报告如下： 一 临床资料：１３例ＧＶ出血患者中１０例以呕血入院,另 ３例则以黑便入院。其中男１１例,女２例,年龄２２岁至 ６８岁,平均４６岁,肝炎后肝硬化９例,酒精性肝硬化４例;肝功能Ｃｈｉｌｄ－Ｐｕｇｈ分级Ａ级７例,Ｂ级４例,Ｃ级２例。 急诊胃镜检查发现单纯ＧＶ４例,ＧＶ－Ｉ型３例,ＧＶ－Ⅱ型４例,混合型２例。其中ＧＶ喷血３例,渗血４例,红色或白色血栓形成…     

食管胃底静脉曲张的内镜治疗

食管胃底静脉曲张破裂出血是门脉高压最严重的并发症之一，其病情凶险，首次出血的死亡率达40％～70％，再出血的发生率为60％～80％。内镜检查不仅可明确食管和(或)胃底静脉曲张破裂出血的诊断，而且还可在内镜直视下行止血治疗。现已证实内镜下注射硬化剂、组织粘合剂或皮圈套扎是治疗静脉曲张破裂出血的有效方法。     

胃底静脉曲张出血的内镜治疗

胃底静脉曲张（Gastric Varices,GV）出血是门静脉高压的严重并发症之一,由于出血迅猛危及患者生命,近几年来随着内镜技术的不断发展,内镜治疗取得令人鼓舞的效果。现就GV的内镜治疗作一综述。     

三种内镜下治疗方法对胃底静脉曲张的疗效

目的 探讨3种内镜下治疗方法对胃底静脉曲张的疗效。方法 将40例胃底静脉曲张患者分为3组进行内镜下治疗，分别为胃底静脉曲张结扎术组(11例)、静脉内注射组织粘合剂组(15例)以及静脉内注射鱼肝油酸钠和凝血酶组(14例)。术后随访6个月，了解其有效率、胃底静脉曲张消失率、再出血率、不良反应发生率以及成本-效益比。结果 3组患者6个月的有效率分别为100．0％、100．0％、72．7％；胃底静脉曲张消失率分别为25．0％、30．8％、0；再出血率分别为27．3％、20．0％、28．6％。结论 胃底静脉曲张结扎术和静脉内注射组织粘合剂的疗效优于静脉内注射鱼肝油酸钠和凝血酶，胃底静脉曲张结扎术的成本-效益比最好。     

超声内镜治疗胃底静脉曲张北大核心CSCD

胃底静脉曲张(GVs)破裂出血严重、复发率和死亡率高,随着超声内镜(EUS)技术的快速发展,通过EUS引导细针穿刺栓塞治疗GVs的新方法不断涌现,特别是EUS引导下弹簧圈置入联合组织胶(或明胶海绵、凝血酶)注射治疗GVs前景广阔,能显著提高临床疗效和安全性。文章对EUS治疗GVs的新技术进行全面综述,重点介绍这些技术的优点、可行性、安全性和局限性。     

内镜下套扎治疗胃底静脉曲张的临床应用

肝硬化门静脉高压常引发严重的食管胃底静脉曲张,对食管静脉曲张内镜下套扎治疗是常用治疗方法,而胃底静脉     

食管胃静脉曲张内镜治疗的最新进展

食管胃静脉曲张(esophagogastricvarices，EGV)出血是肝硬化门静脉高压症最凶险的并发症之一，防治EGV出血对于延长肝硬化患者的生存期至关重要。现简述近年来内镜诊治EGV的新进展如下。     

无痛胃镜下治疗胃底静脉曲张疗效初探

近年来，内镜下治疗食管静脉曲张已得到广泛开展，取得了满意的临床效果，但对胃底静脉曲张(GV)的诊治，研究报道尚少。作者自2001年11月到2003年5月，在无痛胃镜下治疗胃底静脉曲张13例，取得了满意效果。     

内镜下治疗食管-胃连通型静脉曲张的研究进展

食管胃静脉曲张破裂出血是肝硬化常见且危重的并发症之一,再出血率及病死率高,食管-胃连通型静脉曲张属于特殊类型静脉曲张,内镜下治疗方法主要包括内镜下静脉曲张硬化术、内镜下组织胶注射及联合序贯治疗等,但在具体方法的选择上还存在一些争议。现就近年来国内外食管-胃连通型静脉曲张内镜下治疗的进展予以综述。     

内镜下硬化治疗在食管胃静脉曲张中的应用及进展

内镜下硬化剂注射术（endoscopic injection sclerotherapy， EIS）是治疗食管胃静脉曲张出血的重要方法之一。近年来众多学者在注射方法的改良方面进行了大量探索研究，获得了大量有意义的结果。本文结合作者自己的体会就EIS在食管胃静脉曲张的应用及进展做一述评。     

Endoscopic management of gastric varices

Understanding the basic pathophysiology and anatomy of gastric varices is critical to the appropriate management of acute variceal bleeding. The high morbidity and mortality of gastric variceal bleeding combined with poor response to treatments for esophageal variceal bleeding has demanded a highly differentiated approach. This review focuses on gastric fundal varices for which the most recent Baveno VI consensus guidelines recommend endoscopic cyanoacrylate-based therapy as first-line intervention. We discuss the evolution of endoscopic techniques, not only to achieve effective hemostasis but also to limit inherent risks and complications. Long-term data reveal that low rebleeding rates are feasible when gastric varices are completely obliterated. Both primary and secondary prophylaxis should become part of standard treatment algorithms.     

胃静脉曲张:临床及内镜特征初探

目的 初步观察胃静脉曲张的临床及内镜特征。方法 回顾分析10年来我院资料完整的胃静脉曲张（GV）85例,并与同期仅有食管静脉曲张（EV）196例对照。结果 GV的检出率占同期静脉曲张的30．2％,其中胃食管静脉曲张I型（GOV－1）占74．1％,GOV－Ⅱ型占22．4％,单纯胃静脉曲张I型（IGV－I）占2．4％,IGV－Ⅱ型占1．2％。GOV型GV的病因以肝硬化门脉高压最多见,IGV型GV主要见于非肝硬化节段性门脉高压;GV的各型的检出率与肝功能Child分级无关,GV合并门脉高压性胃病（PHC）发生率高于EV（P＜0．01）。GOV－Ⅱ较GOV－I合并PHG的检出率高、程度重,GOV－Ⅱ较GOV－I合并EV的程度重;而GV的出血率显著低于EV（P＜0．01）。结论 Sarin分类法简单、实用,适合国内推广应用。GV并非少见,检出率占全部静脉曲张的30．2％,其中,GOV－I最多见,GOV－Ⅱ次之,IGV较少,而GV出血较EV少见。     

Update on management of gastric varices

Gastric varices(GV) have different physiology and clinical characteristics compared to oesophageal varices(OV). There is little information about the management of GV. Most part of the recommendations is extrapolated from studies where the majority of participants had OV. Thus, most recommendations lack of strong evidence. This is a comprehensive review on all aspects of management of GV, i.e., primary, secondary prophylaxis and management of acute bleeding. The papers on which international societies' recommendations are based are scrutinised in this review and areas of research are identified.     

Safety of direct endoscopic necrosectomy in patients with gastric varices

AIM: To determine the feasibility and safety of transgastric direct endoscopic necrosectomy(DEN) in patients with walled-off necrosis(WON) and gastric varices. METHODS: A single center retrospective study of consecutive DEN for WON was performed from 2012 to 2015. All DEN cases with gastric fundal varices noted on endoscopy, computed tomography(CT) or magnetic resonance imaging(MRI) during the admission for DEN were collected for analysis. In all cases, external urethral sphincter(EUS) with doppler was used to exclude the presence of intervening gastric varices or other vascular structures prior to 19 gauge fine-needle aspiration(FNA) needle access into the cavity. The tract was serially dilated to 20 mm and was entered with an endoscope for DEN. Pigtail stents were placed to facilitate drainage of the cavity. Procedure details were recorded. Comprehensive chart review was performed to evaluate for complications and WON recurrence. RESULTS: Fifteen patients who underwent DEN for WON had gastric varices at the time of their procedure. All patients had an INR 1.5 and platelets 50. Of these patients, 11 had splenic vein thrombosis and 2 had portal vein thrombosis. Two patients had isolated gastric varices, type 1 and the remaining 13 had 5 mm gastric submucosal varices on imaging by CT, MRI or EUS. No procedures were terminated without completing the DEN for any reason. One patient had self-limited intraprocedural bleeding related to balloon dilation of the tract. Two patients experienced delayed bleeding at 2 and 5 d post-op respectively. One required no therapy or intervention and the other received 1unit transfusion and had an EGD which revealed no active bleeding. Resolution rate of WON was 100%(after up to 2 additional DEN in one patient) and no patients required interventional radiology or surgical interventions. CONCLUSION: In patients with WON and gastric varices, DEN using EUS and doppler guidance may be performed safely. Successful resolution of WON does not appear to be compromised by the presence of gastric varices, with similar rates of resolution and only minor bleeding events. Experienced centers should not consider gastric varices a contraindication to DEN.     

Successful endoscopic obturation of gastric varices with butyl cyanoacrylate

In 27 patients who had bled from esophagogastric varices, large-sized and/or actively bleeding gastric varices were endoscopically obturated with the tissue adhesive butyl cyanoacrylate. Active bleeding was stopped in six patients. Rebleeding occurred in 10 patients; in four patients, rebleeding was due to ruptured gastric varices, occurred early and was successfully treated by reinjection of gastric varices; in one patient, rebleeding was attributed to ulceration on an injected gastric varix. Eight patients died: two of rebleeding (from esophageal varices or undetermined source), four of sepsis and/or liver failure and two at home of undetermined cause. No specific complication due to injection of gastric varices was observed. The results obtained in this series of patients with gastric varices obturated by injection of butyl cyanoacrylate are much more satisfactory than those obtained in previously published series of patients with gastric varices treated by injection of sclerosants.