内镜套扎加脾动脉栓塞治疗食管静脉曲张的疗效观察

上消化道出血是肝硬化门静脉高压和晚期肝癌的主要合并症和重要致死因素，现在对脾脏的研究认为，它不仅是造血器官，同时也是免疫器官，我们采用内镜套扎加部分脾动脉栓塞术既可使曲张静脉消失，又能降低脾血流量，降低门静脉压，起到了对消化道出血的治疗作用，同时也保留了脾脏免疫功能和造血功能。     

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。     

内镜下曲张静脉套扎治疗食管静脉重度曲张患者60例

目的观察内镜下密集套扎和非密集套扎治疗重度食管静脉曲张患者的疗效。方法将60例肝硬化并发食管静脉重度曲张患者分为两组,32例(A组)采用密集套扎,28例(B组)采用非密集套扎。两组均采用6连发套扎器行内镜下治疗。以一次使用套扎圈<6个为非密集套扎,>6个为密集套扎。结果在A组32例患者中,套扎1次者7例,2次者20例,3次者5例,平均套扎1.9次。首次平均每例患者结扎12个点。在首次套扎1月后复查胃镜发现,食管静脉曲张治愈、有效和无效者分别为6例(18.8%)、24例(75.0%)和2例(6.3%)。1例患者在术后5个月因肝肾综合征而死亡;在B组28例患者中,套扎1次者1例,2次者8例,3次者16例,4次者3例,平均套扎2.8次。首次每例患者结扎6个点。首次套扎1月后复查胃镜发现食管静脉曲张治愈、有效和无效者分别为1例(3.6%)、24例(85.7%)和3例(10.7%)。1例患者在术后10天因消化道大出血而死亡。两组疗效比较,无显著性差异(P>0.05)。结论采用内镜下套扎法治疗食管静脉曲张有效,但如何操作使治疗更有效还需要进一步观察。     

食管静脉曲张出血急诊内镜套扎482例疗效分析

食管静脉曲张出血是消化内科常见的急危重症,是肝硬化患者的主要致死原因。随着内镜技术的提高,内镜下食管静脉曲张套扎术（EVL）成为治疗肝硬化食管静脉曲张的安全有效方法,其对减少食管静脉曲张再出血、改善患者预后起到明显的作用。急诊内镜下套扎对肝硬化食管静脉曲张出血的治疗,具有术中风险大、技术要求高的特点。为此,我们总结482例该类治疗的经验,报道如下。     

内镜套扎治疗食管静脉曲张出血的疗效

目的 评价内镜套钆治疗肝硬化门脉高压食管静脉曲张出血的远期效果。方法 内镜低位密集套扎，首次套扎6－12点，后隔2周重复套扎直至食管静脉曲张完全闭塞和缩小至I度以下。追踪时间，第1次于治后3个月，第2交于治后6－12个月，以后每年1次。追踪发现复发者动员再次套扎。结果 21例中套扎1次3例，2次10例，3次8例。近期止血效果好。随访1－3年，再出血8例，死于再出血4例。死亡病例中肝功能按Child's分级属C级为主。结论 套扎治疗食管静脉曲张出血远期疗效，以反复多次套扎使食管静脉曲张呈根治状态的病例效果好，出血复发率亦低。远期存活率与肝功能损害程度有关。     

肝硬化食管静脉曲张内镜下套扎临床疗效分析

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.     

内镜下套扎术治疗肝硬化食管曲张静脉破裂出血的效果分析

目的探讨内镜下套扎治疗肝硬化食管静脉曲张疗效的影响因素。方法肝硬化食管静脉曲张患者165例行内镜下食管曲张静脉套扎术(EVL)治疗,分析肝硬化者113例与肝硬化断流术后者52例行EVL术后近期及远期疗效,并观察各种相关因素对EVL疗效的影响。结果EVL治疗后EV总消失率为88.48%,EV复发率27.27%。肝硬化断流手术组与肝硬化组比较,EV复发率低,差异有显著性意义(P<0.05);EVL术前肝功能状态越差,EV和EVB再发生率越高(P<0.01),生存率越低(P<0.05);EV复发组门静脉内径和脾静脉内径较非复发组宽,有显著性差异(P<0.01);EVL术后服用哌唑嗪可降低门静脉内径、减少EV复发(18.07%)、EVB再发率(15.66%),提高生存率(85.54%,P<0.01)。结论EVL是治疗EVB安全有效的方法,近期及远期疗效确切,EVL术后服用哌唑嗪可降低门静脉压力、减少EV复发和EVB再发生率。     

内镜下食管静脉曲张套扎术联合生长抑素治疗肝硬化食管静脉曲张出血的疗效

目的 探讨内镜下食管静脉曲张套扎术(EVL)联合生长抑素注射液治疗肝硬化食管静脉曲张出血的疗效.方法 回顾性分析2018年2月至2020年6月邯郸市第一医院消化内科接受治疗的肝硬化食管静脉曲张出血患者81例的临床资料.按照治疗方法的不同分为对照组(n=34)和观察组(n=47),对照组患者采用内镜下EVL治疗,观察组患...     

食管静脉曲张出血内镜套扎术远期疗效观察

近年来国内外研究资料表明,应用内镜套扎术(EVL)对食管静脉曲张(EV)破裂出血(EVB)有良好的急性止血和预防再出血的效果,但多数报告随访时间仅仅1年左右。因此,人们的印象是,EVL的止血效果是暂时的,EV会反复出现,需要反复进行内镜治疗。本文旨在探讨经内镜定期随访,评估EVL能否达到长期止血的目的。 1 对象和方法 1.1 临床资料 近年来我院使用EVL治疗肝硬化并发EVB共481例。选择以下病例作为研究对象:①经EVL治疗后食管静脉曲张(EV)已消失或≤Ⅰ度者。②坚持内镜随访至少1年以上。③合并原发性肝癌、肝肾综合征或者EVL后接受门腔静脉分流术者除外。入选对象共74例。其中男56例,女18例,年龄24～69岁,平均45.8岁。肝功能Child-Pugh     

内镜结扎-脾栓塞联合疗法治疗门静脉高压症

我院自1999年10月至2003年7月对49例肝硬化门静脉高压患者行食管曲张静脉内镜结扎术（EVL）联合部分脾栓塞术（PSE）治疗门静脉高压症，疗效较好。     

Therapeutic effects of endoscopic variceal ligation combined with partial splenic embolization for portal hypertension

AIM: To evaluate the feasibility of a new strategy of endoscopic variceal ligation combined with partial splenic embolization (EVL-PSE) for patients with cirrhosis and portal hypertension. METHODS: From May 1999 to May 2002, 41 cases with cirrhosis and portal hypertension underwent EVL-PSE. Hemodynamics of the main portal vein (MPV), the left gastric vein (LGV) and azygos vein, including maximum velocity, flow rate and vein diameter, were assessed by Doppler ultrasonography. RESULTS: One case died from pulmonary artery embolism. One case complicated with splenic abscess was successfully managed by laparotomy. The esophageal varices and hypersplenism were well controlled after EVL-PSE in other patients. After EVL-PSE, the flow rate and velocity of MPV was significantly reduced (P<0.05), as well as the flow rate of the LGV and azygos vein. During the follow-up, no recurrent bleeding was found. CONCLUSION: Being more convenient and less invasive, EVL-PSE is hopeful to be a proper intervention strategy for portal hypertensive patients with impaired hepatic function or those intolerant to shunting or devascularization surgery.     

内镜套扎联合部分脾栓塞术治疗门脉高压症的并发症分析

目的 探讨内镜套扎(EVL)联合部分脾栓塞术(PSE)治疗门脉高压症的并发症发生因素及对策,提高该方法的安全性.方法 112例肝硬化失代偿期患者,根据治疗方法分为三组,单纯EVL组(A组)37例.单纯PSE组(B组)35例,EVL联合PSE组(C组)40例.定期随访,比较A、C两组静脉曲张闭塞情况、再出血率;B、C二组外周血象变化;三组术后并发症发生率.结果 A、C组食管静脉曲张均已完全闭塞,A组再出血率18.9%,C组未见再出血.B、C两组病例白细胞与血小板术后1周和2周均有显著升高(P<0.05),血红蛋白的浓度则无明显变化.与EVL有关的轻微咽痛或胸骨后疼痛A组占81.1%,C组占80.0%.在PSE治疗后的患者中,脾塞后综合征在B组占85.7%,C组占87.5%;腹水在B组占42.9%,C组占65.0%;脾脓肿在B组占17.1%,C组占17.5%.结论 EVL术后并发症轻微,病人易于接受;PSE术后并发症病情严重,需要临床治疗,其预后与围手术期处理有关.     

内镜下套扎联合经皮经肝TH胶栓塞治疗肝硬化食管胃底静脉曲张的临床应用

目的评价内镜下套扎(EVL)联合经皮经肝曲张静脉TH胶栓塞术(PTVE)治疗肝硬化食管胃底静脉曲张出血的远期疗效。方法 44例肝硬化食管胃底静脉曲张出血患者,先行食管曲张静脉的内镜下套扎治疗,1周后再行TH胶PTVE,栓塞食管胃底曲张静脉区域及其来源血管。联合治疗术后定期复查胃镜,观察曲张静脉消失情况,随访治疗后曲张静脉复发率及再出血率。结果 44例食管胃底静脉曲张患者,32例食管曲张静脉基本消失,消失率72.7%;8例胃底静脉曲张基本消失,消失率100%;12例食管静脉曲张程度明显减轻,总有效率100%。随访6~39个月,平均25.6个月,5例食管静脉曲张复发,复发率11.4%;3例再出血,再出血率6.8%。结论内镜下套扎治疗能机械性地消除食管曲张静脉,经皮经肝TH胶栓塞能栓塞食管胃底曲张静脉区域及其供血血管,二者联合能达到协同作用,具有更好的远期疗效。     

经皮经肝组织粘合剂栓塞联合内镜下套扎治疗食管静脉曲张的临床应用

目的 探讨经皮经肝组织粘合剂(TH胶)栓塞(PTVE)联合内镜下套扎(EVL)治疗食管静脉曲张的合理性和临床疗效.方法 23例食管静脉曲张患者先行PTVE使TH胶栓塞胃冠状静脉主干及胃底贲门周围静脉,1个月后对食管黏膜下曲张静脉行内镜下套扎治疗.结果 该组患者TH胶未栓塞食管下段曲张静脉,PTVE后静脉曲张缓解,但未完全消失;联合EVL后17例患者静脉曲张基本消失,消失率73.9%.21例行1次套扎治疗,2例行2次套扎治疗,平均套扎次数1.1次/例.随访3～31个月(平均19.2个月),静脉曲张复发或加重3例(13.1%),2例(8.7%)患者门脉高压性胃病出现少量出血.结论 经皮经肝TH胶栓塞能阻断冠状静脉主干、食管胃底周围血管等曲张静脉的供血血管,而内镜下套扎治疗则消除食管下段黏膜下曲张静脉,二者联合可优势互补,从而取得更好的远期疗效.     

栓塞介入治疗食管胃底静脉曲张破裂出血的临床观察

我院自1998年至2003年，采用经皮经肝食管胃曲张静脉栓塞术（PTVE）联合部分性脾栓塞（PSE）进行治疗食管胃底静脉曲张破裂出血50例，现将观察结果报道如下。[第一段]     

Clinical trial of prophylactic endoscopic variceal ligation for esophageal varices

Endoscopic variceal ligation is an effective therapy for variceal bleeding, and use of the method has recently been increasing. We evaluated the clinical usefulness of prophylactic endoscopic variceal ligation. Twenty-two patients with enlarged, tortuous varices and red color signs were selected. These patients were treated with ligation therapy alone and the varices were eradicated, i.e., reduced to small, straight varices without red color signs. Ligation therapy was withdrawn if the general condition of the patient worsened or if the varices could not be removed by suction. Follow-up endoscopy was performed every 4 months, and another ligation was performed if there were recurrent varices or variceal bleeding. The total reduction rate was 86.4%, and eradication required two sessions of therapy and 30 days of hospitalization on average. Complications included esophageal injury in 1 patient and treatment-induced bleeding in 1 patient; both complications were easily controlled. No variceal bleeding occurred after the eradication. There was no mortality due to gastrointestinal bleeding during the median follow-up period of 346 days. Prophylactic endoscopic variceal ligation made it possible to prevent fatal variceal bleeding with a minimum risk of complications, suggesting that this could be an alternative method for the prevention of first-time variceal bleeding.     

Endoscopic variceal ligation (EVL) combined with partial splenic embolization (PSE)

BACKGROUND/AIMS: The effectiveness of reducing the recurrence rate of esophageal varices by combining partial splenic embolization (PSE) with endoscopic variceal ligation (EVL) was investigated. METHODOLOGY: Patients with complete eradication of esophageal varices were collected as study cases with the following results: 31 cases with PSE and EVL (PSE+EVL group), 25 cases with EVL alone (EVL group), and 33 cases with EIS alone (EIS group). The cumulative recurrence rates were obtained by observing new varices. RESULTS: The cumulative recurrence rates at 6 months were 21.1% in the PSE+EVL group, 58.1% in the EVL group and 32.5% in the EIS group. Those at 1 year were 37.0%, 70.7% and 50.2%, respectively, and those at 2 years were 58.1%, 80.4% and 73.0%, respectively. For all 3 time periods, recurrence rates of the PSE+EVL group were significantly lower than those of the EVL group (p=0.042). Cumulative rates in the PSE+EVL group tended to be lower than those in the EIS group. Further analysis was made on the comparative recurrence rates of the 3 groups, according to Child's classification. The cumulative recurrence rates in Child A cases did not significantly differ between the 3 groups. Cumulative rates in Child B cases were significantly lower in the PSE+EVL group than in the EVL group (p=0.032), and those in the PSE+EVL group tended to be lower than those in the EIS group. These trends were observed between the PSE+EVL group and the EVL group in Child C cases, while cumulative rates did not show differences between the PSE+EVL group and the EIS group. CONCLUSIONS: It was inferred that PSE-combined EVL therapy is a very effective therapy for achieving long-term complete eradication of esophageal varices.