内镜下套扎治疗食管静脉曲张19例体会

1995年2月以来,我们采用内镜下套扎术治疗食管静脉曲张患者19例,现报告如下。 资料与方法:本组男16例,女3例;年龄28～67岁。均为肝炎后肝硬化,且发生过上消化道出血。4例有门脉高压手术史,2例曾行硬化剂注射治疗。入院时活动性大出血3例。肝功能按Child分级A级2例,B级12例,C级5例。 内镜下见19例患者共有曲张静脉62条。共进行42次、117处曲张静脉结扎,每例每次套2～4条,每条套1～3点,至被套静脉形成的静脉球变紫,2～3次为一疗程。 结果:2周后复查,静脉球均脱落,无残留溃疡。疗程结束后复查,显效(曲张静脉完全消失)11例,有效(曲张静脉条数减少50％以上,且明显塌陷、变细、变短)8例,3例活动性出血均即刻止血,成     

联合治疗食管曲张静脉破裂出血

食管曲张静脉破裂出血是肝硬化门脉高压的严重并发症之一，常因急性大出血造成严重 后果。自 1994年至今，我们采用胃镜下局部治疗配合奥曲肽静脉注射治疗 62例患者，取得 满意效疗效，报告如下： 1.材料与方法：本组病例均经胃镜检查证实为肝硬化合并食管曲张静脉破裂出血。其中 男 49例，女 13例。年龄 32～ 67岁，平均 52.3岁。其中乙型肝炎后肝硬化 50例，丙型肝 炎后肝硬化 6例，酒精性肝硬化 6例。肝功能 Child分级： B级 36例， C级 26例。其中首 次出血者 24例，再次出血者 20例，第 3次出血者 18例 (包括脾切除后再出血 6例 )。 …     

内镜下套扎术治疗肝硬化食管静脉曲张出血—附15例报告

食管静脉曲张破裂出血是肝硬化门脉高压最严重的并发症,死亡率极高.内镜下套扎术(EVL)是近几年刚在国内应用治疗食管静脉曲张出血的新方法.我们应用该疗法治疗肝硬化食道静脉曲张15例,初步显示其优点及不足,现总结如下.1 临床资料1.1 病例来源:选择肝炎后肝硬化伴食管静脉破裂出血住院病人15例,男12例,女3例,年龄29～68岁,其中3例曾行脾切除术,全部均先经保守治疗后活动性出血控制,均未曾行硬化治疗.15例中.重度静脉曲张10例,中度曲张5例,无1例有胃底静脉曲张.肝功能分级:Child A级9例,B级3例,C级3例.1.2 设备及方法:采用天津天医医用硅胶制品厂生     

内镜下套扎术预防肝硬化食管静脉曲张破裂出血的远期随访观察

目的 观察肝硬化食管静脉曲张患者分别行食管静脉曲张套扎术(endoscopic variceal ligation,EVL)和口服普萘洛尔后的再出血发生率、死亡率、治疗前后静脉曲张程度以及肝功能分级变化.方法 共纳入患者118例,其中66例采用EVL治疗,52例采用药物预防治疗.EVL 治疗组给予多次套扎,直到曲张静脉消失;药物治疗组给予普萘洛尔,起始剂量10 mg,每日2次,逐渐增至最大耐受剂量.对所有患者随访20个月,观察比较两组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 EVL治疗组有效随访58例,其问发生出血7例(12.1%),死亡2例(3.4%);药物治疗组有效随访46例,期间发生出血14例(30.4%),死亡6例(13.0%),两组间差异有统计学意义(P<0.05).EVL治疗组总静脉消失率为41.3%(24/58),药物治疗组46例曲张静脉均未消失;比较两组治疗前后肝功能未见明显变化(P>0.05).结论 与服用普萘洛尔相比,EVL能显著降低出血率、死亡率和静脉曲张程度,且对肝功能无明显损害作用.     

联合治疗法治疗食管静脉曲张破裂出血1168例

近年来国内开展了内镜下硬化和套扎术治疗肝硬化门静脉高压并食管胃底静脉曲张破裂出血,虽获得较好的疗效,但长期疗效仍不理想,尤其是血管闭塞消失率不高以及有曲张静脉闭塞后再通的可能性。笔者采用联合治疗法观察其对食管静脉曲张的长期疗效,现总结并分析如下。1　资料与方法1.1　临床资料:选择经胃镜检查证实的食管胃底静脉曲张伴有新鲜出血或非新鲜出血的患者1168例。其中男1098例,女70例;平均年龄52.8岁。肝炎后肝硬变1156例,酒精性肝硬化6例,胆汁性肝硬化3例,肝窦状核变性2例,Budd-Chiari综合征1例。肝功能Child分级为A级406例,B级5…     

门静脉-肠系膜上静脉广泛栓塞1例并文献复习

背景内镜下套扎术是食管胃静脉曲张出血的一线治疗方法.食管胃静脉曲张密集套扎后形成门静脉-肠系膜上静脉广泛新发血栓临床罕见.病例简介本文回顾性分析1例乙肝肝硬化脾切除术后食管胃静脉曲张出血患者,经食管胃底曲张静脉密集套扎治疗后出现门静脉-肠系膜上静脉广泛新发血栓,积极给予抗凝治疗后,新发血栓消失.结论对于肝硬化脾切除术后食管胃静脉曲张出血,尤其同时存在慢性门静脉血栓者,如需行套扎治疗,勿使套扎范围过密,不要追求一次性全部阻断血流,以防门静脉-肠系膜上静脉新发血栓形成.     

硝苯吡啶、雷尼替丁预防食管静脉套扎术并发症的研究

内镜下食管静脉套扎术（ EVL）前怎样降低门静脉压力,防止术中出血、术后继发性胃静脉曲张,门脉高压性胃粘膜病变（ PHG）加重所致出血,为此,我们使用硝苯吡啶,雷尼替丁解决以上问题,疗效显著。现总结如下： 　　一、临床资料： 1995年 7月至 1997年 10月共用 EVL治疗 63例患者。男 49例,女 14例,年龄 25～ 70岁。其中肝炎后肝硬化 48例, 2例伴原发性肝癌,酒精性肝硬化 5例,血吸虫性肝硬化 10例。多次出血病史 13例,未出血 20例,出血后套扎 16例。肝功 Child A级 15例, B级 24例, C级 24例。食管静脉重度曲张 37例,中…     

内镜下食管静脉曲张套扎术23例疗效观察

1996年以来 ,我们采用内镜下食管静脉曲张套扎治疗(EVL)食管静脉曲张破裂出血患者 2 3例 ,效果良好。现总结如下。一般资料 :本组男 18例 ,女 5例 ;年龄 38～ 5 7岁。均为肝炎后肝硬化患者 ,其中 Child分级 A级 8例、B级 7例、C级 8例。 2 3例均有 1～ 2次出血史。 9例静脉曲张为中度 ,14例为重度 (曲张静脉堵塞食管腔 )。治疗方法 :常规做内镜检查前准备。采用国产套扎器 ,先将 2 5 cm长的外套管套在内镜身上 (采用连发式套扎器者 ,不需用外套管 ) ,然后插入内镜 ,沿镜身推进外套管 ,以建立内镜通道。在内镜下确定套扎点以后拔出内镜。…     

食管曲张静脉套扎治疗致腹水增加26例

上消化道出血是消化内科危重症 ,其常见原因是食管静脉曲张破裂出血 ,常可危及生命。目前广泛采用食管曲张静脉套扎治疗。我院自 1998年采用食管曲张静脉套扎治疗 ,其止血率高 ,疗效满意 ,但也发现一些并发症 ,如门脉高压性胃黏膜病变 ,腹水增加等。前者己屡见报道 ,而后者报道较少。材料与方法1 临床资料 :所有病人均为 1998年 9月～ 2 0 0 1年 6月在我科住院病人 ,共 46例 ,均经肝功、B超、CT确诊为肝硬化失代偿期。其中男 40例 ,女 6例。年龄 2 2～ 60岁 ,平均年龄 41岁。乙肝 3 8例 ,丙肝 6例 ,酒精肝 2例。child pugh分级 :A级 2 0例…     

内镜下套扎联合部分脾动脉栓塞术治疗食管静脉曲张破裂出血

目的探讨内镜食管曲张静脉套扎联合部分脾动脉栓塞术治疗胃底食管静脉曲张破裂出血的疗效。方法对30例肝硬化食管胃底静脉曲张破裂出血病人行内镜下曲张静脉套扎术（EVL），联合部分脾动脉栓塞术（PSA）。观察近期止血效果、远期出血率、脾脏厚度和外周血细胞变化。结果联合术后病人脾功能亢进缓解，远期出血率降低，无严重并发症。结论EVL＋PSE是治疗肝硬化食管静脉曲张破裂出血和脾功能亢进安全有效的方法。     

Successful use of danaparoid in the treatment of portal vein thrombosis that developed in a warfarin-administered hepatitis C virus-related cirrhosis patient

An 84-year-old woman with hepatitis C virus-related cirrhosis, hepatocellular carcinoma and atrial fibrillation, who presented with hematemesis, was initially treated with endoscopic variceal ligation (EVL) for an esophageal varix hemorrhage. However, computed tomography (CT) upon admission had revealed portal vein thrombosis, despite having received warfarin for existing atrial fibrillation. We subsequently initiated a 2-week treatment with danaparoid;warfarin being discontinued in order to reduce the risk of re-hemorrhage. A follow-up CT after treatment revealed complete reduction of the portal vein thrombosis. This is the first successful report of danaparoid use in the treatment of portal vein thrombosis that developed in a patient who had received warfarin.     

Splenogastrorenal shunt in portal hypertension: a little known entity. Study of 6 cases and review of the literature

The authors report 6 cases of portal hypertension with gastrorenal shunt. This shunt did not arise from the left gastric vein, but from the splenic vein. Portal hypertension was related to alcoholic cirrhosis in 3 cases, to extensive portal thrombosis in 2 cases, and to nodular regenerative hyperplasia of the liver in one case. A gastrointestinal hemorrhage revealed portal hypertension and the liver disease in the 3 cases of alcoholic cirrhosis and complicated the course of the disease in the other cases. Hemorrhage was either massive and life-threatening or often recurred. It was related to a rupture of fundic varices in all cases. The fundic varices were not associated with esophageal varices in the 3 cases of cirrhosis. The degree of portal hypertension was above 20 mm Hg, as assessed by the portohepatic gradient (one case), or the pressure gradient between a tributary portal system vein and the inferior vena cava during laparotomy (5 cases). Definitive control of hemorrhage could not be achieved by endoscopic variceal sclerotherapy (2 cases) or percutaneous transhepatic embolization (one case). Portacaval shunt or splenectomy was performed in 5 cases. These findings suggest that spontaneous splenogastrorenal shunt is a clinical and hemodynamic entity which requires specific treatment when associated with gastric variceal bleeding.     

经皮经肝曲张静脉栓塞治疗断流术后食管胃底静脉破裂出血的疗效

目的 研究以组织胶为主要栓塞材料,采用经皮经肝曲张静脉栓塞术(PTVE)治疗和预防门奇静脉断流术后食管胃底静脉曲张破裂出血的临床疗效.方法 2006年11月至2008年9月,对22例曾行断流术再发食管胃底静脉曲张破裂出血的患者行PTVE组织胶栓塞(n=10)或内镜下硬化剂(EIS,n=12)治疗,随访两组患者治疗后再出血率、死亡率、治疗前后静脉曲张和肝功能以及PTVE治疗组患者在曲张侧支静脉栓塞前后门静脉压力的变化.结果 ①在平均12.5个月的随访期内,PTVE治疗组患者再出血率和死亡率分别为1/10和0;EIS治疗组随访13.4个月,患者再出血率和死亡率分别为7/12和3/12,两组问差异有统计学意义(P<0.05).②PTVE和EIS治疗均可显著减轻食管和胃底静脉曲张程度.③对有门静脉血栓患者,PTVE联合门静脉球囊成形术,可以改善肝脏门静脉血供.④PTVE和EIS治疗均未加重肝功能损伤.结论 对门奇静脉断流术后食管胃底静脉破裂出血的患者,采用以组织胶为主要栓塞材料的PTVE治疗的疗效优于EIS治疗.     

Transjugular intrahepatic portosystemic shunt for palliative treatment of portal hypertension secondary to portal vein tumor thrombosis

AIM: To evaluate the palliative therapeutic effects of transjugular intrahepatic portosystemic shunt (TIPS) in portal vein tumor thrombosis (PVTT) complicated by portal hypertension. METHODS: We performed TIPS for 14 patients with PVTT due to hepatocellular carcinoma (HCC). Of the 14 patients, 8 patients had complete occlusion of the main portal vein, 6 patients had incomplete thrombosis, and 5 patients had portal vein cavernous transformation. Clinical characteristics and average survival time of 14 patients were analysed. Portal vein pressure, ascites, diarrhoea, and variceal bleeding and circumference of abdomen were assessed before and after TIPS. RESULTS: TIPS was successful in 10 cases, and the successful rate was about 71%. The mean portal vein pressure was reduced from 37.2 mmHg to 18.2 mmHg. After TIPS, the ascites decreased, hemorrhage stopped and the clinical symptoms disappeared in the 10 cases. The average survival time was 132.3 d. The procedure failed in 4 cases because of cavernous transformation in portal vein and severe cirrhosis. CONCLUSION: TIPS is an effective palliative treatment to control hemorrhage and ascites due to HCC complicated by PVTT.     

Sequelae after Esophageal Variceal Ligation and Sclerotherapy: A Prospective Randomized Study

Objectives: Esophageal variceal ligation is a new approach to the treatment of esophageal varices that does not result in transmural tissue injury and inflammation, and therefore might produce fewer sequelae and symptoms than sclerotherapy. We conducted a prospective, randomized comparison of sclerotherapy with ligation to study the relative short-term risks of these two procedures with respect to bacteremia, pulmonary and coagulation function, esophageal motility, and gas-troesophageal reflux. Methods: Patients with previously documented high grade esophageal varices were randomized to receive sclerotherapy or ligation. Blood was drawn for culture and coagulation profiles, and patients underwent pulmonary function tests, esophageal ma-nometry, and intraesophageal pH monitoring before and after treatment. Results: Six patients with Childs class B cirrhosis and one patient with presinusoidal portal hypertension underwent 20 courses of therapy. Neither sclerotherapy nor ligation produced significant clinical changes in pulmonary or coagulation parameters, or bacteremia requiring treatment. The majority of ligation treatments were without worsening of motility or reflux scores, and none were associated with symptoms. Sclerotherapy was followed by significantly greater esophageal dysmotility and worsening reflux patterns. Conclusions: Patient acceptance of ligation was much greater than that for sclerotherapy. Our data define the advantages of ligation over sclerotherapy.     

肝硬化门脉高压食管胃底静脉曲张破裂出血内窥镜治疗失败后再手术时机探讨

目的 探讨肝硬化门脉高压食管胃底静脉曲张破裂出血内窥镜治疗失败后的再手术时机。方法采用回顾性调查的方法,分析2005年1月至2010年12月48例肝硬化门脉高压症食管胃底静脉曲张破裂出血内窥镜治疗失败后再手术患者病例临床资料,根据术前内窥镜治疗次数分为A组21例,术前内窥镜治疗≤3次;B组27例,术前内窥镜治疗〉3次。比较两组病例术中、术后临床指标情况。结果 A组在胃左静脉血栓发生率、手术时间、术中出血量、断流前及断流后门静脉压力、术后并发症发生率、食管胃底静脉曲张复发率明显低于B组,B组行食管下段横断吻合术比例明显低于A组（P均〈0.05）。结论 肝硬化门脉高压食管胃底静脉曲张破裂出血患者在内窥镜治疗3次失败后,应该及时进行手术治疗。     

Argon plasma coagulation prevents variceal recurrence after band ligation of esophageal varices: preliminary results of a prospective randomized trial

BACKGROUND: Endoscopic variceal ligation is an established procedure for eradication of esophageal varices. However, varices frequently recur after endoscopic variceal ligation. Argon plasma coagulation has been used as supplemental treatment for eradication of varices and for prevention of variceal recurrence in small uncontrolled series. The aim of this study was to determine whether argon plasma coagulation is effective in reducing variceal recurrence after endoscopic variceal ligation. METHODS: Thirty patients with cirrhosis, a history of acute esophageal variceal bleeding, and eradication of varices by endoscopic variceal ligation were randomized to argon plasma coagulation (16 patients) or observation (14 patients). The 2 groups were similar with respect to all background variables including age, Child-Pugh score, presence of gastric varices, and degree of portal hypertensive gastropathy. In the argon plasma coagulation group, the entire esophageal mucosa 4 to 5 cm proximal to the esophagogastric junction was thermocoagulated circumferentially with argon plasma coagulation in 1 to 3 sessions performed at weekly intervals. Endoscopy was performed every 3 months to check for recurrence of varices in both groups. RESULTS: During the course of the study, no serious complication was noted. After argon plasma coagulation, transient fever occurred in 13 patients and 8 complained of dysphagia or retrosternal pain/discomfort. Mean follow-up for all patients was 16 months (range 9-28 months). No recurrence of varices or variceal hemorrhage was observed in the argon plasma coagulation group, whereas varices recurred in 42.8% (6/14) of the patients in the control group (p < 0.04) and bleeding recurred in 7.2% (1/14). CONCLUSIONS: Argon plasma coagulation of the distal esophageal mucosa after eradication of esophageal varices by endoscopic variceal ligation is safe and effective for reducing the rate of variceal recurrence.     

食管静脉曲张结扎术后门脉高压性胃病加重的相关因素分析

目的分析食管静脉曲张结扎术（EVL）后导致门脉高压性胃病（PHG）加重的各种相关危险因素。方法回顾性分析154例肝硬化患者施行EVL前后PHG的加重程度。结果43例有门奇静脉断流术史伴H．pylori阳性者,EVL前后患者重度PHG的总构成比分别为51．16％和74．42％（P〈0．05）;按肝功能Child—Pugh（A＋B）级、C级分组,各组患者EVL前后的重度PHG构成比分别为30．77％、38．46％（P〉0．05）和60．00％、90．00％（P〈0．05）。33例有门奇静脉断流术史H．pylori阴性者,EVL前后的重度PHG总构成比分别为21．21％和36．36％（P〈0．05）。按肝功能Child—Pugh（A＋B）级、C级分组,各组患者EVL前后的重度PHG总构成比为14．29％、21．43％（P〉0．05）和26．32％、47．37％（P〈0．05）。15例无门奇脉断流术史H．pylori阳性者,EVL前后的重度PHG的总构成比分别为20．00％和40．00％（P〈0．05）;按肝功能Child—Pugh（A＋B）级、c级分组,各组患者EVL前后的重度PHG构成比分别为16．67％、16．67％（P〈0．01）和22．22％（1／6）、55．56％（P〈0．01）。46例无门奇脉断流术史鼠pylori阴性者,EVL前后重度PHG的总构成比分别为17．39％和23．91％（P〉0．05）;按肝功能Child—Pugh（A＋B）级和c级分组,各组患者EVL前后的重度PHG构成比分别为14．29％、19．05％（P〉0．05）和20．00％、28．00％（P〈0．05）。结论肝硬化患者EVL前后的重度PHG构成比率与肝功能Child—Pugh分级呈明显正相关;门奇静脉断流术、H．pylori感染均为肝硬化患者EVL后引起PHG程度加重的重要危险因素。     

Hepatic infarction with portal thrombosis

A case of hepatic infarction with portal thrombosis is reported. A 63-year-old woman with liver cirrhosis and esophageal varices was admitted for treatment of the esophagel varices. Endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS) were performed. Two months later, she experienced right hypochondralgia and right flank pain. Serum transaminase levels were suddenly elevated, and computed tomography scans of the liver showed multiple small nodular lesions. Her condition worsened, and she died of hepatic failure. Autopsy revealed splenic and portal vein thrombosis, multiple hepatic infarction, and evidence of chronic pancreatitis. We believe that liver cirrhosis and chronic pancreatitis were the main risk factors for the portal thrombosis, and the treatment for esophageal varices appeared to have triggered the thrombosis. The hepatic infarction was caused by the portal thrombosis.     

经皮穿脾食管胃底静脉栓塞术治疗血吸虫病上消化道出血

目的探讨经皮穿脾食管胃底静脉栓塞术(PTSVE)在治疗血吸虫病肝硬化上消化道出血中的应用价值。方法以血吸虫病肝硬化门脉高压合并食管胃底静脉曲张破裂出血患者16例(均为食管静脉套扎及硬化治疗术后再次出血患者)为研究对象,其中男12例,女4例。所有病例在X线透视引导下,实施PTSVE术。术后观察手术成功率、并发症发生率,术后1月复查CT,比较患者治疗前后静脉曲张程度。结果 14例(87.50%)患者PTSVE术取得成功,均获有效止血;2例(12.50%)失败;1例术后1周出现腹腔出血。术后1月复查CT,经评估显示患者食道静脉(P0.001)、食道旁静脉(P0.001)和胃底静脉(P0.001)曲张程度均较治疗前明显降低。结论 PTSVE治疗血吸虫病上消化道出血是安全有效的方法,该方法特别适合肝硬化严重,肝裂明显增宽,门静脉主干甚至分支裸露者。