新消化道静脉曲张记录方法在内镜治疗食管胃底静脉曲张出血中的作用研究

目的 探讨新消化道静脉曲张记录方法(LDRf分型)在内镜治疗食管胃底静脉曲张出血中的作用。方法 对104例肝硬化食管胃底静脉曲张破裂出血患者行急诊内镜下检查,采用新消化道静脉曲张记录方法,根据曲张静脉不同位置和直径选择硬化治疗术(EIS)、套扎治疗术(EVL)或者组织胶治疗术。观察术中、术后并发症的发生情况,并于1个月后复查胃镜观察食管胃底静脉情况。结果 104例中食管静脉曲张(Le)93例,食管胃静脉曲张(Le,g)36例,胃静脉曲张(Lg)3例。102例(98%)患者急诊止血成功,1例(2%)止血失败,表现为术后6d内反复便血,行经颈静脉肝内门腔静脉内支架分流术治疗后出血停止。术后1个月复查胃镜,见42例(45.16%)食管静脉曲张消失,56例(60.22%)中上段食管静脉基本消失。28例(71.2%)胃底静脉曲张消失,33例(84.61%)患者可观察到多种形态的排胶形式,如球状、点状等,颜色为黑色、黄白色以及褐色等。术后常见的并发症有咽下不适、胸骨后痛、低至中度发热,发生率为15.9%,未发生严重并发症。结论 采用新消化道静脉曲张记录方法在内镜治疗食管胃底静脉曲张出血中,对治疗方法的选择具有指导意义,有助于提高内镜下治疗成功率,减少并发症发生。     

内镜治疗食管胃静脉曲张的效果分析

目的探讨内镜下套扎、硬化剂、组织粘合剂治疗食管胃静脉曲张的临床疗效。方法选择有食管、胃静脉曲张破裂出血史的患者107例,进行胃镜检查,依据LDRf分型结果选择内镜下套扎、硬化剂或者组织粘合剂治疗食管胃静脉曲张并随访。结果进行内镜下套扎治疗52例,硬化剂治疗18例,组织粘合剂治疗8例,硬化剂加组织粘合剂治疗15例,未进行内镜下治疗14例。结论内镜下治疗食管胃底静脉曲张破裂出血操作简单、疗效可靠、止血率高、静脉曲张消失快、并发症少,是治疗食管胃底静脉曲张破裂出血的有效方法。LDRf内镜下分型简单明了、规范、统一,对于食管胃静脉曲张的内镜下治疗有指导意义。     

内镜套扎术与硬化剂治疗食管及胃底静脉曲张

目的:探讨内镜套扎术与硬化剂治疗食管及胃底静脉曲张的疗效及并发症。方法:用多环结扎器进行内镜下套扎术治疗食管静脉曲张30例,其中14例合并胃底静脉曲张者应用硬化剂治疗。结果:全组30例患者,食管静脉曲张消失或基本消失22例;合并胃底静脉曲张14例,胃底静脉曲张消失或基本消失8例。随访26例,4例出现大出血。结论:内镜套扎术联合硬化剂治疗食管胃底静脉曲张是安全有效、切实可行的,是预防其破裂出血积极有效的措施。     

三腔单囊管牵引内镜下注射硬化剂治疗食管静脉曲张大出血患者的护理

目的 提高内镜下注射硬化剂或组织肢治疗食管静脉曲张破裂大出血的效果.方法 将三腔二囊管去除食管囊后于胃管腔插入沙氏导丝,经鼻或经口插入20例食管静脉曲张破裂大出血患者食管和胃中,牵引下进行内镜注射5%鱼肝油酸纳、组织胶于曲张静脉.术前做好患者与物品准备,术中配合三腔单囊管插入及硬化荆和组织胶注射,术后予以镇痛、并发症观察等护理.结果 14例一次治疗出血停止,6例加用组织胶后出血停止,有效止血率100%.结论 充分做好患者的术前心理护理,术中与术者密切配合,术后严密观察,可提高食管静脉曲张大出血救治成功率.     

胃镜下注射硬化剂(聚桂醇)治疗食管静脉曲张的护理配合

目的:探讨胃镜下注射硬化剂治疗食管静脉曲张的有效护理配合.方法:32例肝硬化食管静脉曲张患者行胃镜下注射聚桂醇治疗,均采取血管内注射,实施常规护理、心理护理及健康指导等措施.结果:32例食管静脉曲张患者治疗成功.术后无明显并发症.结论:内镜下食管静脉曲张硬化剂治疗可有效治疗急性出血、预防再出血,提高生存率,且操作方便、安全,便于推广.精心的护理配合是治疗成功的关键因素之一.     

食管胃底静脉曲张破裂出血患者硬化剂治疗后行肝移植术并发贲门狭窄一例

<正>食管胃底静脉曲张破裂出血(esophageal gastric variceal bleeding,EGVB)是肝硬化失代偿期患者的一种严重并发症,内镜下注射硬化剂治疗出血,快捷且效果较好,但注射硬化剂后远期并发症值得关注。兰州大学第二医院为1例曾行硬化剂治疗的肝硬化伴EGVB患者行肝移植术,术后患者出现贲门狭窄,经长期多次治疗,效果不佳,最终行外科手术彻底治愈。对于可行肝移植治疗的EGVB患者应采取何种     

内镜止血治疗在消化道出血中的临床应用

随着内镜下止血技术的普及,内镜治疗目前已成为消化道出血的首选止血方法［1］。通过内镜下寻找出血点,并利用多种止血技术进行及时止血,多可避免外科手术。目前临床常用内镜止血技术包括注射硬化剂止血术、金属钛夹止血、术氩离子凝固术和冰去甲肾上腺素止血术等,各种止血治疗均有不同优势,内镜止血也常需要联合应用几种不同的止血技术。复旦大学附属中山医院内镜中心自2012年1-12月间对32例不同原因引起的消化道出血患者进行内镜下止血治疗,取得满意效果,现总结报道如下。     

内镜下组织黏合剂联合硬化剂注射治疗胃静脉曲张临床研究及随访

目的 ：分析和随访内镜下组织黏合剂联合硬化剂注射治疗门静脉高压症胃静脉曲张的疗效及预后。方法：研究纳入2006年至2015年期间84例上消化道出血,胃镜检查显示胃静脉曲张,行内镜下组织黏合剂联合硬化剂注射治疗的病人,比较治疗前后出血频率,随访胃静脉曲张消除率及疾病转归。结果：84例病人内镜治疗共111例次,平均治疗（1.32±0.68）次/例。内镜治疗前出血（0.72±0.54）次/月,治疗后出血（0.30±0.82）次/月,两者比较差异有统计学意义（P<0.01）。内镜治疗后6个月内胃静脉曲张根除（基本消失）率为75.0%,治疗6个月后为70.8%。术后随访（14.82±19.30）个月内未发生再出血,术后无异位栓塞与感染并发症发生。结论：内镜下组织黏合剂联合硬化剂注射治疗有效降低胃静脉曲张出血频率,改善曲张静脉状态,是预防胃静脉曲张再出血的重要方法之一,可在临床应用推广。     

内镜下注射组织黏合剂治疗胃静脉曲张

胃底静脉曲张的诊断和治疗一直是临床关注的课题。随着消化内镜技术的不断发展．食管胃静脉曲张破裂出血的抢救成功率明显提高。经内镜进行组织黏合剂注射治疗食管胃静脉曲张出血及预防再次出血安全、有效．急性及远期并发症较少．已经成为治疗胃静脉曲张的首选方法。     

内镜腹腔镜联合治疗肝硬化门静脉高压症食管胃底曲张静脉出血

目的：探讨内镜腹腔镜联合治疗肝硬化门静脉高压症食管胃底曲张静脉出血的可行性。 方法： 23例肝硬化门静脉高压症食管胃底曲张静脉出血患者行食管曲张静脉套扎或胃底曲张静脉组织胶注射后行手助腹腔镜脾切除11例,门奇静脉断流术12例。 结果：21例术后1年内无上消化道出血,2例因出血行再次套扎。1例于2年后患肝癌死亡,1例3年后上消化道出血死亡。 结论：内镜联合腹腔镜治疗肝硬化门静脉高压症曲张静脉出血创伤小,近期止血效果好,是一种切实可行的治疗门静脉高压症并食管胃底静脉曲张出血的方法。     

食管尖锐异物取出过程中透明帽的应用效果和经验

目的探讨透明帽在食管尖锐异物取出术中的有效性及安全性。方法回顾分析2015年1月至2017年1月我院内镜中心取出的食管尖锐异物124例。男性76例,女性48例。年龄16~82岁。无透明帽辅助胃镜取出组54例,透明帽辅助胃镜下取出组70例。比较两种治疗的视野清晰率,异物取出时间、成功率、粘膜损伤发生率,出血及穿孔等并发症发生率。结果透明帽辅助组患者异物取出平均时间为(234.14±67.38)秒,无透明帽辅助者取出平均时间为(337.11±116.61)秒,前者比后者时间明显缩短,具有统计学差异P0.05)。透明帽辅助组取出成功率及视野清晰率优于无透明帽辅助组,具有统计学差异(P0.05),透明帽辅助组患者粘膜损伤发生率及并发症发生率均低于无透明帽辅助组,具有统计学差异(P0.05)。结论应用透明帽辅助取食管尖锐异物可明显缩短手术时间,提高视野清晰可及成功率,降低粘膜损伤率,减少并发症发生率,是一直安全有效的方法,具有良好的临床价值。     

Treatment of esophageal varices by sclerotherapy in children

Bleeding from esophageal varices may be a serious or lethal complication of portal hypertension in children. The standard therapy over the past 30 years has been to create a portosystemic shunt. In children physiologic complications leading to high rates of perioperative morbidity and early and late thrombosis with recurrence and encephalopathy have been common. Over a 42 month period, we treated six patients aged 5 to 18 years, with endoscopic injection of 3 percent sodium tetradecyl sulfate into the varix. Five patients required only injection, whereas one underwent direct oversewing of gastric varices followed by endoscopic sclerosis of the esophageal varices which remained. A total of 38 endoscopic procedures were performed. There has been complete cessation of bleeding in two patients, minimal subsequent bleeding in two others, and anemia requiring transfusion in the last two treated. These last two patients, although still requiring occasional transfusions, have been free from hypotensive or exsanguinating hemorrhage since beginning sclerotherapy. No deaths or serious complications were encountered in this series. Follow-up has ranged from 18 to 42 months (mean 26 months). The results of this trial suggest that repeated endoscopic sclerotherapy of varices, combined with operative oversewing of gastric varices when necessary, offered a viable alternative therapy for patients with esophageal varices.     

Endoscopic clipping versus band ligation in the management of bleeding esophageal varices

BACKGROUND: The effectiveness of endoscopic clipping in the hemostasis of bleeding esophageal varices and the eventual variceal eradication was compared with that of band ligation. METHODS: Forty patients were enrolled in the study in a prospective manner, 19 of whom received endoscopic clipping (group I) and the remaining (n = 21 patients) received endoscopic band ligation (group II). All patients in this study presented with bleeding from esophageal varices. The patient characteristics (age, sex, Child-Pugh score, variceal grade) were comparable in the two groups. After initial hemostasis, the patients were assigned one of the two forms of endoscopic therapy which was continued in the follow-up sessions until varices were eradicated. Early and late results were compared. RESULTS: Initial hemostasis was achieved in all patients in group I but two patients in group II required clip ligation for initial hemostasis because of the failure in band ligation. Those two were treated with band ligation in the follow-up sessions. A total of 224 clips in 53 treatment sessions and 296 bands in 82 treatment sessions were placed in group I and group II, respectively. The rates of complete variceal eradication were 89% and 76% in group I and group II, respectively (p > 0.05). The median number of required treatment sessions for complete eradication of the varices was significantly lower in group I than group II (3 versus 4, p = 0.013). Three patients from group I (15%) and seven patients from group II (33%) were readmitted for variceal bleeding during the follow-up period (p > 0.05). CONCLUSIONS: With the advantages of high initial hemostasis rate, decreased risk of rebleeding, and fewer treatment sessions needed for variceal eradication, endoscopic clipping is as effective as band ligation, or perhaps more effective in the treatment of bleeding esophageal varices.     

Use of Hemostatic Matrix for Hemostasis of the Cavernous Sinus during Endoscopic Endonasal Pituitary and Suprasellar Tumor Surgery

The endoscopic endonasal approach offers a wide, panoramic exposure of the sellar floor, planum, and clivus. The ability to expose fully the tumor margins, through lateral extension of cavernous sinuses, increases the exposure and ability to resect the tumor but increases the risk of bleeding. The authors describe achieving hemostasis using a hemostatic matrix, FloSeal (Baxter Biosciences, Vienna, Austria) sealant, during endoscopic endonasal tumor removal, specifically for pituitary and suprasellar tumors. Thirty-nine cases (33 pituitary adenomas, 4 craniopharyngiomas, 1 clival plasmacytoma, and 1 planum meningioma) are described using this technique. FloSeal was injected directly to the site of bleeding, and a cottonoid was used for further tamponade, immediately achieving hemostasis with no hemorrhagic complications in any of the patients. Surgery could be immediately pursued without any delay. This simple nuance can be used as a safe method in cavernous sinus hemostasis during endoscopic endonasal surgery and may decrease operative time.     

Less frequent causes of upper gastrointestinal bleeding

Upper gastrointestinal (GI) bleeding represents emergency which despites modern advances in treatment still carry substantial mortality. Mortality remained relatively constant in the last 50 years at approximately 12%. Peptic ulcers remain the most common cause of upper GI bleeding and account approximately 50% of all cases. Next leading causes are esophageal and gastric varices, and gastroduodenal erosions. Mallory Weiss tears, angiodysplasia and gastric antral vascular ectasia (GAVE)-Watermelon stomach are less frequent but important causes of upper GI bleeding that contribute substantially to the overall morbidity and mortality. Recognition of such lesions is crucial to provide effective hemostasis. In most cases endoscopic therapy is procedure of choice which significantly improved the outcome of patients. In cases where endoscopic hemostasis is not effective, or patients rebleed after initial control surgical therapy may be required. This article will review recent advances in diagnosis and therapy of upper GI bleeding caused by Mallory Weiss tears, angiodysplasia or Watermelon stomach.     

止血夹预防高危出血患者ERCP术后迟发性出血的临床效果

目的 探讨出血高危患者在内镜下逆行胰胆管造影（endoscopic retrograde cholangio pancreatography,ERCP）术中即刻留置止血夹对预防术后迟发性出血的临床作用。方法 收集2016年8月至2019年9月来院行ERCP的1 854 例患者,其中符合纳入标准的出血高危患者493 例,包括止血夹组215 例、常规对照组278 例,回顾性分析两组患者术后并发症包括出血、胰腺炎、穿孔,以及操作时间、住院时间和住院费用等指标。结果 止血夹组术后出血发生率低于常规对照组[1.4%（3/215） vs 4.7%（13/278）,P＜0.05],两组在性别、年龄、疾病构成、术后胰腺炎和穿孔、操作时间、取石方式、住院费用等指标上无统计学差异（P＞0.05）。结论 ERCP术中针对出血高危患者预防性实施止血夹,可以显著降低术后迟发性出血发生率,且不额外增加患者费用,是一种安全便捷、值得推广的技术。     

Urgent transjugular retrograde obliteration for prophylaxis of rebleeding from gastric varices in patients with a spontaneous portosplenorenal shunt

BACKGROUND: Bleeding isolated gastric varices with a spontaneous portosplenorenal shunt are difficult to control. The urgent use of transjugular retrograde obliteration (TJO) to prevent early rebleeding and to improve early mortality has not yet been demonstrated. We report our experience with this technique in patients with isolated gastric varices after treatment of acute bleeding. METHODS: We reviewed our experience of 6 patients with isolated gastric varices with a spontaneous portosplenoral shunt treated with TJO after treatment of acute bleeding. We basically applied endoscopic glue embolization using cyanoacrylate monomer for treatment of acute bleeding. TJO was a method using an occlusive balloon catheter to control a spontaneous portosplenorenal shunt flow while injecting sclerosant retrograde into the gastric varices. RESULTS: Treatment of acute bleeding was achieved immediately by endoscopic glue embolization, endoscopic variceal ligation, and ligating the varices with sutures following anterior gastrotomy in 4, 1 and 1 patients, respectively, and then TJO was performed. Permanent hemostasis and variceal eradication was achieved in these 6, and they all survived. They were alive for 6-66 months without gastric variceal recurrence. CONCLUSIONS: We conclude that urgent TJO is effective in the prophylaxis of early and late rebleeding from isolated gastric varices in patients with a spontaneous portosplenorenal shunt.     

Endoscopic diagnosis and treatment of upper gastrointestinal bleeding

Considerable progress has been made in endoscopic hemostasis. Several methods are available. Sclerotherapy of esophageal varices is the procedure of choice for the control of active variceal hemorrhage and for the prevention of recurrent bleeding. For endoscopic treatment of nonvariceal gastrointestinal bleeding, the nonerosive contact probes (heater probes and BICAP) and injection sclerotherapy are preferred. Several hemostatic modalities should be available and applied depending on the anatomic location and type of bleeding lesions. Advanced endoscopic hemostatic techniques seem to be decreasing the mortality rates in patients with upper gastrointestinal bleeding.     

手术、内镜下治疗食管胃底静脉曲张出血的近期和远期疗效观察

目的 比较内镜下食管静脉套扎术（EVL）联合硬化剂注射（EVS）和食管胃底静脉断流术对食管胃底静脉曲张破裂出血的近期和远期疗效,探讨EVL结合EVS和两种方法单独应用的适应证。方法12例肝硬化门脉高压症患者行食管胃底静脉断流术,术后胃镜观察曲张静脉消失程度及合并出血的情况,其中6例术后做了EVL或EVS;32例行EVL结合EVS;9例单纯行EVS;5例单纯行EVL。所有病例术后随访3年,观察曲张静脉消失和复发程度以及出血情况。结果 食管胃底静脉断流术为急诊止血的可靠方法,但术后仍存在程度不同的曲张静脉,术后3年内再出血发生率高达66.7％（8/12）,术后择期行EVL或EVS,曲张静脉可完全消退。EVL结合EVS曲张静脉完全消退达93.75％（30/32）,总疗程2-3周。内镜下治疗后3年内观察曲张静脉复发率仅为10.53％（4/38）,再出血发生率为6.52％（3/46）。结论EVL结合EVS对食管胃底静脉曲张破裂出血的近期和远期疗效明显优于手术组。食管胃底静脉断流术后施行EVL和/或EVS可以同时达到降低门脉高压和消除曲张静脉目的。EVL结合EVS明显优于两者单独应用的疗效,同时避免了单纯用EVS容易引起出血的可能性,并且缩短了单纯用EVL的疗程,克服了后期套扎的难度。