急诊内镜下套扎治疗肝硬化食管静脉曲张出血疗效观察

目的：探讨急诊内镜下套扎治疗肝硬化食管曲张静脉破裂出血的临床疗效。方法：对68例肝硬化食管静脉曲张出血的患者行急诊内镜下套扎治疗。结果：急诊止血成功率94．1％；止血成功后近期再出血5例，其中2例行2次套扎止血成功；2例止血失败，2例近期再出血患者行血管介入手术后止血成功；死亡3例。结论：急诊EVL是治疗肝硬化食管静脉曲张破裂出血的一种安全而有效方法。     

内镜下食管静脉曲张及其出血治疗的护理体会

食管静脉曲张破裂出血是肝硬化病人的主要并发症和致死原因,内镜下食管静脉曲张套扎术是目前预防和治疗食管静脉曲张破裂出血的有效方法之一,预防和治疗肝硬化食管静脉曲张出血是降低死亡率的关键,而内镜下套扎治疗已经代替了硬化疗法成为现在急性静脉曲张出血的最普遍的治疗方法。近年来,我院消化内镜中心用六连发套扎器对该类患者进行了治疗和护理,取得了良好的疗效,现报告如下。     

国产组织胶内镜下注射联合套扎治疗食管胃底静脉曲张的临床应用

目的探讨国产组织胶内镜下注射联合套扎治疗食管胃底静脉曲张的临床效果。方法24例食管胃底静脉曲张患者。分三种方法治疗：（1）套扎＋组织胶注射1次完成10例;（2）套扎与组织胶注射分次完成10例;（3）采用组织胶直接注射治疗4例。结果4例活动性出血经治疗均即刻止血,成功率100％,10例套扎＋组织胶注射1次完成者,食管和胃底静脉曲张治疗总有效率100％;10例套扎＋组织胶分次完成者,食管静脉曲张治疗总有效率90％,胃底静脉总有效率80％,两组疗效比较无统计学意义;并发症：总发生率12．5％（3／24）,2例注射完拔针后少许出血,1例术后2周排胶出血,经适当处理均止血。结论国产组织胶注射联合套扎治疗食管胃底静脉曲张和／或出血,近期疗效可靠、操作安全,并发症少而轻。     

预防性套扎治疗重度食管静脉曲张63例分析

近年来,随着内镜设备、技术水平的不断提高,内镜下食管静脉曲张硬化剂注射疗法（ES）、内镜下食管静脉曲张套扎疗法（EVL）等方法凭借其近期疗效良好、降低出血及再出血发生率、显著提高生存率等优点,已逐渐成为治疗食管静脉曲张破裂出血的常用方法。但对于未发生过上消化道出血的重度食管静脉曲张患者,是否需要进行预防性套扎治疗尚存疑义。     

肝硬化套扎联合硬化序贯治疗的疗效评价

  目的 探讨套扎联合硬化序贯治疗对肝硬化食管静脉曲张的疗效。方法 选取医院2014-04至2017-04诊断为肝硬化并食管静脉曲张出血经过2次食管静脉曲张套扎治疗,食管静脉曲张内镜分级仍在中(G₂)、重(G₃)度的57例患者为研究对象,根据随机数字表法将受试者随机分为对照组(28例)和研究组(29例),研究组行套扎联合硬化序贯治疗,对照组继续行套扎序贯治疗。两组均在治疗后随访1年并复查胃镜,比较两组的序贯治疗次数、食管静脉曲张消除率、再出血发生率、并发症发生率。结果 研究组食管静脉硬化术序贯治疗次数(2.24±0.95)少于对照组食管静脉套扎术序贯治疗次数(3.29±1.27),两组比较有统计学差异(P＜0.05)。研究组静脉曲张消除率(89.66%)显著高于对照组(46.43%),再出血率(2.45%)低于对照组(14.29%),两组比较差异有统计学意义(P＜0.05)。两组并发症发生率比较差异无统计学意义(P＞0.05)。结论 套扎联合硬化序贯治疗可减少内镜下治疗次数,显著减少套扎术后残留的食管曲张静脉、延缓静脉曲张的复发,并发症风险无增加。     

内镜下组织黏合剂栓塞术治疗食管胃底静脉曲张出血的临床研究

目的比较内镜下套扎法及组织黏合剂注射法治疗肝硬化胃底静脉曲张的临床疗效。方法将154例肝硬化食管胃底静脉曲张患者随机分为内镜下套扎组(对照组)及组织黏合剂注射组(观察组),观察两组患者的再次出血发生率、曲张静脉改善有效率及并发症的发生率。结果两组患者手术均成功,均无严重的并发症发生。随访9个月,观察组3、6、9个月内再出血发生率明显低于对照组,而曲张静脉改善的有效率明显高于对照组,差异有统计学意义(P<0.05)。结论内镜下注射组织黏合剂能更加有效的预防再出血的发生,其临床疗效更为确切,可作为治疗食管胃底静脉曲张的首选方法。     

食管静脉曲张42例套扎后早期再出血的诱因分析及护理对策

食管静脉曲张破裂出血是肝硬化的严重并发症,死亡率高。内镜下食管静脉曲张套扎术（EVL）系经过结扎曲张静脉血管使套扎处组织缺血、坏死、脱落,静脉内血栓形成,血管闭塞,从而达到止血和预防出血的目的。因其简单、容易掌握、     

急诊TIPS治疗食管胃底静脉曲张破裂出血38例的护理

食管胃底静脉曲张破裂出血是肝硬化门脉高压患者常见的并发症之一,并且起病急、进展快、病情凶险、死亡率高。食管胃底静脉曲张破裂出血的治疗主要包括内镜下套扎或硬化剂治疗、介入治疗及手术治疗等[1]。内镜下套扎或硬化剂治疗食管胃底静脉曲张破裂出血效果显著,但不能改变门脉高压[2]。而外科手术治疗创伤大,患者耐受性差。经颈静脉肝内门体静脉内分流术(transjugular     

奥曲肽对食管静脉曲张破裂出血的疗效观察

目的观察奥曲肽对食管静脉曲张破裂出血的疗效。方法50例食管静脉曲张破裂出血住院病例（均为胃镜证实）随机分为两组：A组（25例）采用奥曲肽治疗，B组（25例）采用垂体后叶素治疗，观察两组止血效果。结果奥曲肽组止血成功率91．5％，垂体后叶素组成功率62％。结论奥曲肽治疗食管静脉曲张破裂出血疗效明显优于垂体后叶素。     

影响经皮经肝食管胃曲张静脉组织胶栓塞术远期疗效因素分析

目的：探讨提高经皮经肝曲张静脉栓塞术（PTVE）治疗食管胃底静脉曲张出血远期疗效的相关因素。方法：192例肝硬化合并食管胃底静脉曲张出血的患者,经皮经肝穿刺向食管下段胃底部曲张静脉、食管下段周围静脉丛、胃底贲门周围静脉丛内注入永久性栓塞剂TH胶（a-氰基丙烯酸酯）。结果：192例患者中188例成功施行了PTVE,成功率达97．8％。168例患者随访期6～64月,根据注入的TH胶分布的范围,168例患者分为3种栓塞类型：食管-胃底型82例,胃底型67例,主干型19例,135例患者PTVE后同时施行部分脾动脉栓塞,42例随访中施行了内镜下套扎或硬化治疗。静脉曲张复发率15．5％（26／168）。胃食管栓塞组静脉曲张复发率明显低于胃底贲门型及冠状静脉主干型（P〈0．0001,log-rank test）。随访期间21例患者再出血,总出血率12．5％（21／168）。其中食管胃底型再出血率3．7％（3／82）;胃底型再出血率10．4％（7／67）;主干型再出血率58．1％（11／19）。联合内镜治疗者再出血为2．4％（1／42）,联合脾动脉栓塞组再出血8．9％（12／135）明显低于单纯PTVE治疗的27．3％（9／33）。结论：TH胶栓塞范围与远期疗效密切相关,联合部分脾动脉栓塞和内镜下套扎治疗能明显降低食管胃静脉曲张复发和再出血。     

影响内镜下食管静脉曲张套扎术疗效的危险因素分析

目的 研究影响内镜下食管静脉曲张套扎术内镜下套扎术(EVL)疗效的危险因素.方法 回顾性分析140例行EVL患者的临床资料,寻找影响EVL疗效的危险因素.结果 早期再出血组与未出血组的出血次数、Grade分级、Child-Pugh分级、门静脉宽度、曲张静脉根数、结扎静脉根数、丙氨酸转移酶、天门冬氨酸转移酶、总胆红素、凝血酶原活动度等观察指标具有统计学差异(P＜0.05),以上各项指标均为EVL术后早期再出血的危险因素.结论 对于食管静脉曲张出血的患者,在行EVL前,应该仔细评价患者的各项临床指标,对患者进行危险分层,做好充分的术前准备,筛除高危患者,尽可能地减少术后早期再出血的发生率,延长患者寿命.     

Risk and causes of gastroesophageal bleeding in patients with liver cirrhosis

BACKGROUND/AIM: Variceal bleeding is the most life-threating complication in liver cirrhosis. The aim of this study was to analyze the sources of gastroesophageal bleeding in patients with liver cirrhosis and to ascertain the risk factors of bleeding from esophageal varices. METHODS: This prospective study included 52 patients with liver cirrhosis and portal hypertension. Severity of liver dysfunction according to Child's classification, coagulation parameters, and endoscopic findings were analyzed. In patients with varices we analyzed the size, color, location of varices, and the presence of red signs. The varices were classified as small, medium and large. RESULTS: Esophageal varices were found in 76.9% of the patients. Isolated varices were present in 36.6%, and associated with other findings in 40.3%. Small varices were present in 10%, medium in 25% and large in 65% patients. Of them 55% had variceal bleeding. Variceal bleeding was present in 50% of the patients with medium and in 65.38% of the patients with large varices. There was no bleeding in the patients with small varices. Endoscopy revealed red signs before bleeding in 85% of the patients with large varices. There was a higher incidence of variceal bleeding in the Child's group B. There were no significant differences (p > 0.05) in the coagulation parameters in patients with and without variceal bleeding. Rebleeding was present in 86.36% of the patients. Most of them (52.63%) were rebleeding between 7 weeks and 12 months after the first episode of variceal bleeding. In the patients with the most severe hepatocellular dysfunction (Child's group C) the period between the first bleeding and rebleeding was the shortest (mean, 20.8 days). CONCLUSION: Our study revealed that esophageal varices are the most frequent sources of bleeding in the patients with liver cirrhosis. There is the association between the first bleeding and large varices and the red signs. Coagulation disorders and hepatic dysfunction were not related to the initial episode of variceal bleeding. The risk of early rebleeding was higher in the patients with severe hepatic dysfunction (Child's class C).     

Evaluation of portosystemic collaterals by SPECT imaging after endoscopic variceal sclerotherapy: usefulness for predicting recurrence.

Bleeding from esophageal varices is a major cause of morbidity and mortality in cirrhotic patients. Identification of patients at high risk for bleeding is particularly important. The aim of this study was to determine whether detection of portosystemic collaterals by SPECT could predict the outcome of endoscopic injection sclerotherapy of esophageal varices and be useful for selecting appropriate therapy. METHODS: Sixty-two patients with liver cirrhosis who were considered at high risk of bleeding were treated with endoscopic injection sclerotherapy. Endoscopy was performed every 3 mo after therapy or until bleeding occurred. Before and within 2 wk after therapy, tomographic images of intra-abdominal blood pool were constructed by SPECT. RESULTS: Before therapy, the following portosystemic collateral routes were observed: coronary veins in 53 (85.5%) of 62 patients, short gastric veins in 8 patients (12.9%), splenorenal shunts in 10 patients (16.1%), and paraumbilical veins in 6 patients (9.7%). Patients positive for imaging of coronary veins were divided into 3 groups on the basis of changes in images after therapy: complete responders (n = 17), whose coronary vein images disappeared completely; partial responders (n = 18), whose images became smaller; and nonresponders (n = 18), whose images did not change significantly before or after therapy. The rates of recurrence after endoscopic injection sclerotherapy until 6 mo in complete responders (4/17, 23.5%) and partial responders (7/18, 38.9%) were significantly less (P < 0.05) than that in nonresponders (11/13, 84.6%). The rate of recurrence of esophageal varices until 6 mo in nonresponders treated with additional submucosal injection sclerotherapy (1/5, 20.0%) was significantly less (P < 0.05) than that in nonresponders without additional submucosal injection sclerotherapy (11/13, 84.6%). CONCLUSION: Abdominal blood-pool SPECT, a noninvasive method, is useful for evaluating the therapeutic effectiveness of endoscopic sclerotherapy, for predicting the recurrence of varices, and for selecting appropriate management after sclerotherapy.     

善得定、垂体后叶素对肝硬化食管胃底静脉破裂出血研究

目的：研究善得定（生长抑素八肽）与国产垂体后叶素在肝硬化食管胃底静脉曲线破裂出血中的止血效果,同时观察了再出血率,病死率和副反应。方法：对102例病例根据经济情况,有无心血管病史随机分为两组,治疗组 静推0.1mg善得定后给36ug/h速度持续静点,垂体后叶素组给垂体后叶素0.4u/min持续静点。结果：善得定治疗组3小时、6小时、12小时、24小时完全止血率依次为16.67%、25%、61.15%和80.56%,垂体后叶素组依次为10％、20％、40％、50％。结论：持续静脉点滴善得定在相同时限止血疗效均较垂体后叶素效果明显,而且副作用少,再出血和存活率两组产现例无明显差异。     

Evaluation of portosystemic collaterals by MDCT-MPR imaging for management of hemorrhagic esophageal varices

Objective

To study the correlation between changes in portosystemic collaterals, evaluated by multidetector-row computed tomography imaging using multiplanar reconstruction (MDCT-MPR), and prognosis in patients with hemorrhagic esophageal varices (EV) after endoscopic treatment.

Methods

Forty-nine patients with primary hemostasis for variceal bleeding received radical endoscopic treatment: endoscopic injection sclerotherapy (EIS) or endoscopic variceal ligation (EVL). Patients were classified according to the rate of reduction in feeding vessel diameter on MDCT-MPR images, into the narrowing (n = 24) and no-change (n = 25) groups. We evaluated changes in portosystemic collaterals by MDCT-MPR before and after treatment, and determined rebleeding and survival rates.

Results

The left gastric and paraesophageal (PEV) veins were recognized as portosystemic collaterals in 100 and 80%, respectively, of patients with EV on MDCT-MPR images. The rebleeding rates at 1, 2, 3, and 5 years after endoscopic treatment were 10, 15, 23, and 23%, respectively, for the narrowing group, and 17, 24, 35, and 67%, respectively, for the no-change group (P = 0.068). Among no-change group, the rebleeding rate in patients with large PEV was significantly lower than that with small PEV (P = 0.027). The rebleeding rate in patients with small PEV of the no-change group was significantly higher than that in the narrowing group (P = 0.018). There was no significant difference in rebleeding rates between the no-change group with a large PEV and narrowing group (P = 0.435).

Conclusion

Changes in portosystemic collaterals evaluated by MDCT-MPR imaging correlate with rebleeding rate. Evaluation of portosystemic collaterals in this manner would provide useful information for the management of hemorrhagic EV.     

硬化剂注射预防食管静脉曲张破裂出血远期疗效研究

目的观察肝硬化食管静脉曲张患者分别行内镜下注射硬化剂（endoscopic injection sclerotherapy,EIS）和口服卡维地洛后的再出血发生率、死亡率和治疗前后食管静脉曲张程度以及肝功能的分级变化。方法入选患者89例,其中50例患者采用EIS治疗,39例患者采用药物预防性治疗,EIS组患者给予多次注射硬化剂,直至曲张静脉消失,药物治疗组给予卡维地洛,起始剂量为6.25mg,每日2次,逐渐增加剂量至最大耐受量12.5mg,每日2次。全部患者观察36个月,对比两组间的再出血发生率和死亡率、治疗前后静脉曲张程度以及肝功能分级变化。结果 EIS治疗组有效随访44例,期间发生出血7例（15.9%）,死亡3例（6.8%）。药物治疗组有效随访34例,期间发生出血10例（29.4%）,死亡4例（11.8%）。两组间再出血发生率和死亡率差异有统计学意义（P〈0.05）。EIS治疗组静脉曲张总消失率为40.9%（18/44）,卡维地洛治疗组曲张静脉均未消失;比较两组治疗前后肝功能Child-Pugh评分未见明显差异（P〉0.05）。结论与药物卡维地洛治疗相比,EIS治疗可以降低再出血发生率、死亡率和静脉曲张程度,同时患者肝功能无明显损害。     

Balloon-occluded retrograde transvenous obliteration of gastric fundal varices with hemorrhage

OBJECTIVE: This study was performed to evaluate the clinical efficacy, feasibility, and complications of balloon-occluded retrograde transvenous obliteration for patients with hemorrhage from gastric fundal varices. SUBJECTS AND METHODS: Between December 1994 and February 2001, 24 consecutive patients with hemorrhage from gastric fundal varices were enrolled in this study. Balloon-occluded retrograde transvenous obliteration consisted of injecting 5% ethanolamine oleate iopamidol through the outflow vessels during balloon occlusion. The treatment was performed during acute bleeding in 11 patients and electively in 13 patients. Among those patients with acute bleeding, six were treated for temporary hemostasis with balloon tamponade, and five were treated endoscopically. RESULTS: Cannulation into the outflow vessels was performed in 23 patients, but the balloon catheter could not be inserted in one patient who had inferior phrenic vein outflow. Complete success was obtained in 88% (21/24) of patients, and partial success was obtained in two patients. In nine of 11 patients with acute bleeding, complete success was achieved. Rebleeding from gastric varices was not observed in patients treated with complete success, whereas two patients treated partially rebled within 1 week of the treatment (rate of rebleeding, 9%). Eradication of gastric varices was obtained in all patients (n = 19) who were examined by endoscopy 3 months after the treatment. Eight patients experienced worsening of esophageal varices. These patients were treated endoscopically because of findings that suggested a risk of hemorrhage. The overall mortality rate was 4% (1/24). No damage to the kidney was observed, although 11 patients had macrohematuria. CONCLUSION: Balloon-occluded retrograde transvenous obliteration followed by any hemostatic procedure might be effective for both prophylaxis of rebleeding and eradication of gastric fundal varices, even in urgent cases.     

Sclerotherapy induced pseudo-carcinoma

Endoscopic sclerotherapy has been suggested as the therapy of choice for acute hemorrhage from esophageal varices. It not only controls such episodes, but also prevents rebleeding, and prolongs life. After treatment, patients may present with endoscopic and radiographic findings which mimic esophageal carcinoma including ulceration, non-pliable walls, irregular mucosal pattern and overhanging edges.