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肝硬化食管静脉曲张内镜下套扎临床疗效分析 总被引:1,自引:0,他引:1
目的 探讨内镜下套扎治疗肝硬化食管静脉曲张出血(esophageal varices bleeding,EVB)的止血效果及影响因素.方法 对123例肝硬化食管静脉曲张(esophageal varices,EV)出血的患者应用内镜下食管静脉套扎术(endoscopic variceal ligation,EVL)进行治疗.结果 所有患者经过1次EVL治疗,EV消失31例(25.2%),EV减轻92例(74.8%),无效0例.近期出血13例,远期出血9例.结论 EVL是治疗肝硬化食管静脉曲张破裂出血的一种有效方法,但并非没有风险,影响疗效因素众多. 相似文献
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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。 相似文献
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Toru Kakinuma Katsunori Shimoji Yukinori Imai Kenji Fujiwara 《Digestive endoscopy》2005,17(2):148-152
Background: Isosorbide dinitrate (ID) improves dysphagia of achalasia patients by lowering the low esophageal pressure. Dysphagia occurs in cirrhotic patients undergoing endoscopic injection sclerotherapy (EIS) for esophageal varices even with no structural abnormalities as its sequela. We tested whether ID can be therapeutic for dysphagia of this type. Methods: ID was given for 2–6 weeks to 13 patients with dysphagia lasting for longer than 4 weeks after EIS despite no esophagolumenal stricture on endoscopy and barium swallows. EIS was done three to six times as an injection series of ethanolamine oleate into the varices at intervals of 1–2 weeks until they were obliterated. The therapeutic efficacy of ID was evaluated by symptom severity four‐degree scorings. Esophageal transit time and emptying time were calculated from the time–activity curves on esophageal scintigraphy. Results: At 2 weeks after ID medication, dysphagia was decreased by one score in 12 of 13 patients, and by two scores in one patient. However, dysphagia at the same extent recurred in nine patients within 6 weeks after stopping ID medication, which was improved similarly by remedication. Two patients in whom dysphagia of one and two scores disappeared after ID medication dropped out because of headache. The remaining two patients remained asymptomatic for longer than 6 months after the first medication. Esophageal scintigraphy disclosed the shortening of the emptying time after ID administration in two patients. Conclusions: ID may be effective for relieving functional dysphagia after EIS for esophageal varices in cirrhotic patients. 相似文献
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Tsujigami K Okamura S Fukuda T Ichikawa S Nakasono M Okita Y Muguruma N Ito S 《Journal of gastroenterology and hepatology》2007,22(12):2064-2068
BACKGROUND AND AIM: The aim of this study was to clarify the etiology and clinical significance of solitary and scattered esophageal varices by evaluating their hemodynamics and other characteristics using infrared endoscopy and endoscopic ultrasonography. METHODS: The study group comprised 44 lesions of these two related types detected in 28 patients by visible-light endoscopy. Infrared endoscopy was used to characterize blue-black coloration before and after rapid intravenous injection of indocyanine green (2 mg/kg). During endoscopic ultrasonography, depth within the esophagus and echo patterns of these varices were characterized. RESULTS: Diameters of these varices were significantly smaller in lesions more strongly staining by infrared endoscopy. Lesion diameter was significantly smaller in varices showing homogeneous low echogenicity than in those showing mixed echogenicity. Lesions showing homogeneous high echogenicity stained most weakly followed in turn by lesions with mixed echogenicity and finally those showing homogeneous low echogenicity. CONCLUSION: Indocyanine green injection was useful for infrared observation of the hemodynamics of solitary and scattered esophageal varices, as was endoscopic ultrasonography in defining the location and morphology of these lesions. Varices with larger diameters stained more persistently when hemodynamics were evaluated by infrared endoscopy, and often showed a mixture of low and high echogenicity by endoscopic ultrasonography. These observations suggest that blood flow in the varices is slowed, and that the risk of hemorrhage increases with increased diameter especially with uniform enhancement and uniform echogenicity. 相似文献
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食管胃静脉曲张是与门脉最相关的侧支循环途径,其破裂可导致静脉曲张出血,是肝硬化最常见的致死性并发症。胃静脉曲张在门脉高压患者中的发生率为5%~33%,总出血概率为3%~30%,其破裂出血引起的病死率高达30%~53%。胃静脉曲张出血控制难度较大,治疗手段又落后于食管静脉曲张。但是从上世纪以来,对于胃静脉曲张的治疗,尤其是介入治疗方面有了巨大的进步,如内镜下血管闭塞治疗、经颈静脉肝内门腔静脉内支架分流术(TIPS)、球囊闭塞下经静脉逆行栓塞术(B-RTO)及经皮经肝食管胃底曲张静脉栓塞术(PTVE)等。这些方法在临床上的合理应用提高了危重患者的生存率,帮助无法耐受手术治疗的门脉高压患者改善生活质量。同时,也为患者等待肝移植创造了时间和条件。 相似文献
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Mizumoto H Matsutani S Fukuzawa T Ishii H Sato G Maruyama H Saisho H 《Journal of gastroenterology and hepatology》2001,16(5):495-500
BACKGROUND: AND METHODS: We examined the changes in portal hemodynamics after endoscopic variceal ligation (EVL) combined with endoscopic injection sclerotherapy (EIS) in relation to post-treatment relapse. The present study included 93 patients who underwent EVL-EIS combination therapy. Portal hemodynamics were examined by Doppler ultrasonography and percutaneous transhepatic portography (PTP). RESULTS: Therapy with EVL-EIS resulted in the complete disappearance of varices in 89 of 93 patients. Cumulative relapse-free rates (Kaplan-Meier method) were 75.8 and 50.2%, respectively, 1 and 3-5 years after treatment. At the end of treatment, the flow in the left gastric vein was examined by Doppler ultrasonography. In 50 of 63 patients, the flow remained hepatofugal. In 23 of these patients, PTP was performed at the end of treatment; selective left gastric venography did not reveal any palisade zone vessels or varices. However, fine blood vessels were seen around the lower esophagus in nine patients, only the paraesophageal vein was found in 10 patients and these two findings were present in four patients, indicating that collateral blood flow remained in the lower esophagus in 13 of 23 patients. These findings suggest that frequent relapse of varices results from insufficient blockage of blood flow from the left gastric vein to the lower esophagus. However, in patients with a patent paraesophageal vein, long-term effects obtained by EVL-EIS combination therapy were satisfactory. CONCLUSIONS: The pattern of the development of collateral left gastric veins represents important hemodynamic changes that predict the long-term prognosis of patients after treatment. 相似文献
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After excluding terminally all patients, we evaluated a total of 718 patients treated with endoscopic injection sclerotherapy.
They involved 350 episodes of acute hemorrhage and 368 prophylactic procedures in patients with risky varices. The 1-year
cumulative survival rate was significantly lower in the acute hemorrhage group than in the prophylactic group (P<0.05). The difference in survival between the two groups was primarily due to the number of deaths in the first 2 months
after sclerotherapy (20.1% vs 0.8%,P<0.0005). Improvements in the sclerotherapy technique significantly reduced the number of deaths from bleeding (9.3% vs 3.4%,P<0.05), but not those from liver failure following variceal hemorrhag. Prophylactic EIS is advantageous in the treatment of
esophageal varices, i.e. it may prevent deaths fromliver failure attributed to variceal hemorrhages. The present study shows
that preliminary prevention of variceal hemorrhage provides favorable hemostatic efficacy in patients with risky varices. 相似文献
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目的探讨经内镜注射氰基丙烯酸酯治疗儿童急性食管-胃底静脉曲张破裂出血的效果和安全性。方法回顾性分析2010年8月-2015年8月在宝鸡市妇幼保健院儿童医院采用经内镜注射氰基丙烯酸酯进行治疗的35例急性食管-胃底静脉曲张破裂出血患儿的临床资料。统计分析治疗后的急诊有效率、再次出血率以及并发症的发生情况。结果 35例患者共经46次内镜注射氰基丙烯酸酯治疗,治疗有效率为95.6%(44/46),每次注射氰基丙烯酸酯的量为0.2~0.6 ml,平均(0.4±0.2)ml。急诊止血率为93.4%(43/46);再次出血4例,占11.4%(4/35),4例复发出血的患者治愈周期为1.2~23.0个月,平均(12.1±10.9)个月。1例患者出现腹痛,无患者并发异位栓塞。2例患者术后死亡。结论经内镜少量多次注射氰基丙烯酸酯治疗儿童急性食管-胃底静脉曲张破裂出血疗效确切,操作方便,并发症少,值得推广。 相似文献
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肝硬化食管静脉曲张出血的急诊内镜下套扎治疗 总被引:21,自引:0,他引:21
目的 探讨急诊内镜下紧急套扎治疗肝硬化食管静脉曲张(EV)破裂出血的安全性及止血效果。方法 对89例肝硬化EV出血患者在急诊状态下紧急内镜套扎,监测套扎术前、术中及结束时血压、心率、呼吸变化,观察套扎过程对生命体征的影响。结果 急诊止血成功率达98.9%,套扎过程对生命体征无明显影响(P均>0.05),术中无并发症发生。近期再出血2例。肝硬化患者76例随访3-30个月,死亡11例,病死率14.5%。结论 紧急EVL治疗肝硬化EV破裂出血是一种安全、有效、快捷的止血方法。 相似文献
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Teruhiro Sakai Tadashi Iwao Kazuhiko Oho Atsushi Toyonaga Kyuichi Tanikawa 《Journal of gastroenterology》1997,32(6):715-719
We investigated the influence of extravariceal collateral channel pattern on the recurrence of esophageal varices after sclerotherapy.
One hundred and fifteen patients with cirrhosis and esophageal varices were studied. They were divided into four groups according
to extravariceal collateral pattern on portal venography. Group 1 patients had neither paraesophageal veins nor gastrorenal
veins (n-49); group 2 patients had paraesophageal veins only (n=30); group 3 patients had gastrorenal veins only (n=25); and group 4 patients had paraesophageal veins plus gastrorenal veins (n=11). Sclerotherapy was repeated to eradicate esophageal varices and follow-up endoscopic examination were performed. The
overall recurrence-free rate at 36 months was 68%. The log-rank test showed the recurrence-free rate to be significantly higher
in group 3 (76%) and group 4 patients (89%) than in group 1 patients (51%;P<0.05 andP<0.05, respectively). Although the recurrence-free rate was higher in group 4 than in group 2 patients (59%), this did not
reach the level of significance (P=0.10). No significant differences were found between other pairs of groups. These results suggest that gastrorenal veins
play an important role in the protection against recurrent esophageal varices after sclerotherapy, while the protective role
of paraesophageal veins appears to be small. 相似文献
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[目的]探讨内镜下急诊套扎治疗食管静脉曲张破裂出血的疗效及安全性。[方法]选择2010年10月~2013年12月的69例食管静脉曲张出血患者,在急诊状态下行内镜套扎治疗,观察疗效、并发症、再出血率及套扎术对生命体征的影响。[结果]急诊止血成功率98.6%(68例)、并发症发生率1.4%(1例)、近期再出血率4.3%(3例),套扎术过程对血压、心率、呼吸等生命体征无明显影响。[结论]急诊食管静脉曲张套扎术治疗食管静脉曲张破裂出血是一种有效、安全、快捷的止血方法。 相似文献
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内镜下组织粘合剂注射联合套扎治疗食管胃底静脉曲张破裂出血的疗效观察 总被引:2,自引:0,他引:2
目的评价急诊内镜下组织粘合剂(α-氰丙烯酸烷基脂)注射联合套扎治疗食管胃底静脉曲张破裂出血的临床疗效。方法2008年1月至2009年1月间21例食管胃底静脉曲张破裂出血患者接受急诊内镜下胃底曲张静脉组织粘合剂注射联合食管曲张静脉套扎(EVL)治疗,对其治疗疗效进行回顾性分析。结果21例患者的急诊止血有效率达95%(20/21),未出现严重并发症。结论急诊内镜下组织粘合剂注射联合套扎治疗食管胃底静脉曲张破裂出血,止血疗效确切,并发症发生率低,值得推广。 相似文献
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Utilizing an equal mixture of 5% sodium morrhuate and 60% renografin, we studied four patients during a total of nine sessions of injection sclerotherapy of esophageal varices to determine radiographically the fate of injected sclerosant. Despite attempted intravariceal injections, 44% resulted in local and presumably paravariceal accumulation of contrast material within the esophageal wall. During 42% of injections, contrast material was rapidly cleared in a cephalad direction and proximal balloon compression of the esophagus did not prevent cephalad flow of sclerosant. In 14% the injected material was rapidly cleared in a caudal direction toward the gastric veins. This technique may be useful in future evaluations of the efficacy of various methods of injection sclerotherapy of esophageal varices. 相似文献
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急诊内镜下套扎与硬化治疗食管静脉曲张破裂出血的比较 总被引:1,自引:0,他引:1
目的比较食管静脉曲张破裂出血急诊内镜下套扎与硬化治疗的疗效和安全性。方法对210例食管静脉曲张破裂出血患者,急诊情况下行内镜下套扎或硬化治疗,并分析比较两组急诊止血成功率、近期再出血率、急诊治疗曲张静脉消失率、不良反应、并发症、病死率等情况。结果急诊止血成功率套扎组达95.4%,硬化组达96.0%;近期再出血率分别为4.8%和4.1%;套扎组急诊治疗曲张静脉消失率明显优于硬化组(P〈0.01)。两组不良反应、并发症及病死率无差别。临床疗效与肝功能呈正相关。结论急诊内镜下套扎与硬化治疗食管静脉曲张出血均为有效、安全的止血方法。临床上可结合患者实际情况综合考虑后选择。 相似文献
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Takahiro Sato Katsu Yamazaki Jouji Toyota Yoshiyasu Karino Takumi Ohmura Toshihiro Suga 《Digestive endoscopy》2004,16(3):257-261
A 72‐year‐old man with type C cirrhosis was admitted to our hospital for refractory esophageal varices. Prophylactic endoscopic injection sclerotherapy (EIS) was performed twice in August 2000 for high‐risk esophageal varices at an outside hospital. However, a therapeutic effect was not attained. Endoscopic ?nding revealed F1, Cb, RC (–) at the gastroesophageal junction to approximately a 5‐cm oral site, and F3, Cb, RC (+) varices at the upper site from the 5‐cm oral site of the gastroesophageal junction. Color ?ow images were obtained of the posterior branch of the left gastric vein and revealed an in?ow‐type perforating vein about a site 5 cm oral from the gastroesophageal junction. Color ?ow images of esophageal varices were detected with endoscopic color Doppler ultrasonography. Color ?ow images of out‐?owing‐type perforating veins were discerned in the middle esophagus. The vessel images of intramural esophageal varices were clearly delineated via an ultrasonic microprobe and showed a perforating vein with a diameter of 4 mm. We performed EIS with an attached balloon to occlude the out‐?owing‐type perforating veins with 5% ethanolamine oleate with iopamidol. Seven days after the ?rst EIS, thromboses were observed in the intramural esophageal varices and in the in?ow type‐perforating veins via ultrasonic microprobe. We exchanged the hemodynamics of this esophageal variceal case with blockade of the in?ow‐type perforating vein. Next, we successfully performed EIS, and achieved the blockade of passageways, including the palisade veins. Forty days after EIS, endoscopic ?ndings revealed disappearance of the esophageal varices. 相似文献