Barium-impregnated fibrin glue: application to a bleeding duodenal sinus

A 64-year-old man with Crohn's disease who had undergone repair of an ileovesical fistula and ileoileostomy had numerous postoperative complications related to sepsis and wound healing. Subsequently, upper gastrointestinal bleeding developed, and the site was identified as a duodenal sinus. Medical management was unsuccessful in controlling the bleeding. Because of the considerable risk associated with reoperation in this seriously ill patient, approval was obtained from the Food and Drug Administration to use fibrin glue in an attempt to prevent further bleeding. The glue was mixed with barium and placed in the duodenal sinus under endoscopic guidance. The barium-impregnated glue facilitated follow-up surveillance with abdominal roentgenography. The patient had no further gastrointestinal bleeding. Further clinical and experimental studies should be conducted to determine the mechanism of action and the efficacy of this application of fibrin glue.     

Wandering spleen presenting as bleeding gastric varices

Ectopic spleen (splenoptosis) is an extremely rare condition in which the spleen is present in a nonanatomical position. Patients' symptomatology is variable and ranges from mere feeling of an abdominal lump to sudden abdominal pain due to infarction. Patient may have subacute to chronic abdominal or gastrointestinal complaints. Because of nonspecific symptoms, clinical diagnosis can be difficult; hence, imaging plays an important role. Presentation as a case of portal hypertension is extremely rare. We report a case of splenic torsion in a middle-aged woman who presented with hemetemesis from gastric varices secondary to chronic volvulus of an ectopic spleen. Preoperative diagnosis was made on the basis of ultrasonography, endoscopy, and computed tomography, which was later proved on surgery and treated successfully.     

组织胶联合金属夹治疗孤立性胃底静脉曲张(IGV1型)21例疗效分析

目的探讨胃镜下组织胶联合金属夹治疗孤立性胃底静脉曲张(IGV1型)的临床疗效。方法回顾分析2015年1月-2016年12月该院胃镜下组织胶联合金属夹治疗肝硬化IGV1型患者21例的临床资料,并结合相关文献进行分析。结果 21患者治疗均顺利完成,第1周、第1个月、第3个月、第6个月复查胃镜,胃底静脉曲张明显减少,无明显大出血、栓塞等严重并发症。结论组织胶联合金属夹治疗肝硬化IGV1型具有临床意义,可为临床处理该类疾病提供参考。     

精准内镜下组织胶治疗胃静脉曲张的临床效果

目的研究精准内镜下组织胶治疗胃静脉曲张的临床价值。 方法回顾性分析2013年3月至2019年11月浙江中医药大学附属杭州市西溪医院内镜下组织胶治疗食管胃静脉曲张3型（GOV3）患者60例,根据内镜下选择治疗胃静脉曲张（GV）的不同,分为精准组和经典组各30例。采用χ²检验比较2组患者治疗后1、3、6个月再出血率、急性门静脉血栓形成、并发症（包括异位栓塞）和转归（包括TIPS/外科手术、死亡率）等方面的差异;采用t检验比较2组患者GV穿刺点数、组织胶用量和Child-pugh评分等方面的差异。 结果2组患者在年龄、性别、病因、Child-pugh评分、急性门静脉血栓形成、呕血/黑便病史、脾切除术、GV联合钛夹等方面比较,差异均无统计学意义（P＞0.05）。精准组6个月累积GV穿刺点数和组织胶应用支数显著多于经典组［（9.07±3.59）点vs（2.90±1.71）点,（9.27±4.27）支vs（3.90±1.95）支,P均＜0.01］。精准组治疗后1、3、6个月再出血率均低于经典组（0 vs 16.7%,3.3% vs 36.7%,10.0% vs 46.7%,P均＜0.05）。2组患者在治疗后Child-pugh评分、发热、急性门静脉血栓形成、异位栓塞、再出血而死亡或转TIPS/手术等方面均无统计学差异［（6.47±1.48）分vs（6.40±1.54）分,10% vs 10%,0 vs 0,0 vs 0,0 vs 6.7%,0 vs 6.7%,P均＞0.05）］。 结论精准治疗可以减少GV组织胶治疗的再出血率。精准治疗发热、急性门静脉血栓形成、异位栓塞等并发症少见,对肝硬化患者Child-pugh评分亦无影响。     

Bucrylate treatment of bleeding gastric varices: 12 years' experience

BACKGROUND AND STUDY AIMS: For several years now there has been an increasingly widespread use of a tissue adhesive in the treatment of bleeding gastric varices to achieve rapid, safe control of hemostasis and prevent rebleeding. In this study we report on our experience with the use of Bucrylate (Hystoacryl) for the treatment of gastric varices over a period of more than a decade. PATIENTS AND METHODS: Since 1988, 174 cirrhotic patients with actively bleeding gastric varices have been admitted to our department, where they received emergency treatment with injections of Bucrylate. Any associated nonbleeding esophageal varices were subjected to traditional sclerotherapy in combination with the Bucrylate treatment. The gastric varices were subdivided into four distinct groups according to the method advocated by Sarin in 1989. The patients underwent weekly sclerotherapy sessions until their varices were eradicated, and the follow-up with a mean of 36 months (range 9-90 months) consisted of endoscopy at 3, 6, and 12 months during the first year and then yearly checks to confirm obliteration of the varices. RESULTS: The hemostasis (97.1%), early rebleeding (15.5%), and hospital mortality (19.5%) rates of the patients with bleeding gastric varices, treated with the tissue adhesive, were very similar to those of patients treated for esophageal varices over the same period (98.1%, 13.0%, and 16.4%, respectively). The most frequent cause of death at 30 days was liver failure (76% of cases), followed by hemorrhagic shock (8.8%), and other less frequent causes. Sclerotherapy achieved obliteration rate for gastric varices (70-75%) similar to that for esophageal varices in those patients with portal hypertension due to intrahepatic block (alcoholic and posthepatitis cirrhosis), but a rate of only 32% in the group of patients with prehepatic block (splenoportomesenteric thrombosis), where surgery proved more effective (69%). The medium- and long-term survival rates depended on the stability of the patients' liver conditions, on rapid, effective control of variceal hemostasis, and on complete, lasting obliteration of the gastric varices. CONCLUSIONS: The use of Bucrylate in emergency sclerotherapy achieved results in bleeding gastric varices on a par with those obtained in esophageal varices in cases of alcoholic and posthepatitis cirrhosis. The group of patients with portal hypertension due to prehepatic block (splenoportal thrombosis) showed no benefit from sclerotherapy in terms of obliteration of gastric varices, but benefited from elective surgery. The choice of the obliterating treatment indicated may be facilitated by classifying gastric varices into distinct groups on the basis of anatomicotopographic criteria.     

胃底静脉曲张出血33例临床分析

目的 分析胃底静脉曲张出血的病因、诊断和治疗方法。方法 回顾分析该院1994年元月～2003年12月检查确诊为胃底静脉曲张出血33例，对其临床资料进行分析讨论。结果 病因：肝硬化门脉高压23例，肝癌6例，脾静脉阻塞4例。治疗结果：内镜下套扎17例；5例于1～3d内复发大出血死亡，另有9例2个月内复发出血，硬化剂治疗4例，均有复发出血；17例行手术治疗，14例术后无再出血，3例虽有复发出血，但频率及出血量明显减少。结论 胃底静脉曲张是门脉高压，特别是脾胃区门脉高压的表现。胃底静脉曲张较食管静脉曲张出血率低，但出血更严重。内镜对胃底静脉曲张的诊断价值有限。对胃底静脉曲张不宜行套扎或硬化剂治疗。能手术者应首选手术治疗，不宜手术者可考虑介入治疗，栓塞胃底静脉。     

纤维蛋白胶在骨科中的应用

背景:纤维蛋白胶是一种生物蛋白制剂,由纤维蛋白原、凝血酶及其他生物活性因子组成,具有止血、趋化及促细胞有丝分裂等特性,有着良好的生物相容性。目的:对纤维蛋白胶在骨科的应用进行综述。方法:以fibringlue,biomaterial,application为英文检索词,以纤维蛋白胶,骨科,应用为中文检索词,检索PubMed、BP、SD、万方及维普等数据库1995-01/2011-05相关文献,选取纤维蛋白胶在骨科中的应用有关文献30篇进行总结。结果与结论:纤维蛋白胶是一种具有多向生物活性的生物蛋白,能迅速形成立体网状结构,起到良好的止血作用。在注射部位局部形成凝胶圈,起封闭与粘合作用。具有预防脊柱手术后硬脊膜外腔粘连,抑制局部炎症扩散,减轻水肿压迫,促进术后切口愈合的作用。能充当生物基质,应用于骨或软骨组织工程。     

内镜硬化联合组织胶治疗危重食管胃底静脉曲张的配合及护理

目的内镜硬化联合组织胶治疗危重食管胃底静脉曲张的配合及护理。方法对115例危重食管静脉曲张破裂大出血患者分别进行内镜下注射硬化剂,组织黏合剂与内镜下组织黏合剂与硬化剂联合注射治疗的配合及护理进行回顾性总结。结果3种方法的急诊止血率分别为81．5％、95.8％、100％;术后发热率分别为73.8％、87．5％、76．9％;胸痛发生率分别为84．6％、70．8％、76．9％;静脉曲张消失率分别为64．5％、31．3％、90％。结论硬化剂与组织黏合剂联合治疗效果优于其他方法,治疗过程中全程护理具有重要的地位,做好内镜下硬化、组织胶治疗的前期准备、配合及病情观察护理,可更好地提高疗效。     

Evolution of fibrin glue applicators

Fibrin glue (FG) is used worldwide as a potent surgical tool, which establishes hemostasis in wounds and also bonds tissue. The standard FG applicator is based on a dual-syringe system. This review, based mainly on the patent literature, describes the development of the quasi-standard dual syringe system as well as the rise of other FG applicator designs based on mechanical force (ratchet systems), Bernoulli gas flow, positive gas pressure, or electro-servo devices. The packaging of commercial FG components is reviewed within the context of “loading” the FG applicators and the need to minimize the number of needles required to access the packaged (vials) components. Parameters such as internal clogging, homogeneity of spray, the requirement for gas or vacuum house lines, the number of parts that must be handled, and the time required to assemble the applicator, load it, and have it ready for use are also discussed. A rating system is proposed that permits one to use such parameters to rank the various applicator designs, relative to the dual-syringe system. Hopefully, this review will stimulate the design of better FG applicators and packaging required for elective surgery, emergency treatments, and tissue engineering in the 21st century.     

食管胃底静脉曲张破裂出血TH胶栓塞治疗的护理

总结30例肝硬化食管胃底静脉曲张破裂出血行TH胶栓塞术治疗的护理。治疗前做好各项准备,治疗中密切观察生命体征,治疗后加强病情观察,及早发现并发症,出院前予详细的指导,对提高治疗成功率具有重要意义。     

肝、脾硬度预测食管胃底静脉曲张及出血风险

目的 探讨肝脏、脾脏硬度诊断乙型肝炎（简称乙肝）肝硬化患者食管胃底静脉曲张（EGV）和评估静脉曲张破裂出血风险的价值。方法 对71例确诊为乙肝肝硬化患者行胃镜、声脉冲辐射力弹性成像（ARFI）等相关检查,对EGV程度分级并测定患者的肝、脾脏剪切波速度（SWV）,绘制ROC曲线,比较其诊断EGV和评估静脉破裂出血高风险的价值。结果 有EGV乙肝肝硬化患者的肝脏SWV（LSWV）和脾脏SWV（SSWV）均高于无EGV乙肝肝硬化患者（P均<0.001）;以胃镜结果为金标准,LSWV、SSWV诊断EGV的ROC曲线下面积（AUC）分别为0.877和0.910（P均<0.001）,最佳界值点分别为2.01 m/s和2.84 m/s,敏感度为93.5%和76.1%,特异度为76.0%和92.0%;其预测静脉曲张破裂出血高风险的AUC分别为0.882和0.914（P均<0.001）,最佳界值点分别是2.27 m/s和2.94 m/s,敏感度为77.1%和85.7%,特异度为83.3%和91.7%。结论 肝脏、脾脏硬度有助于诊断乙肝肝硬化患者EGV以及预测静脉曲张破裂出血风险。     

Failure of cyanoacrylate tissue glue (Flucrylate, MBR4197) to stop bleeding from experimental canine gastric ulcers.

A plastic tissue adhesive, trifluoroisopropyl 2-cyanoacrylate (Flucrylate (TM), MBR4197), was tested for hemostatic efficacy in acute laparotomy experiments using a canine model of acute bleeding gastric ulcer. An improved delivery system suitable for endoscopic use was developed. Hemostatic efficacy of the adhesive was tested in both briskly bleeding ulcers and in oozing ulcers after partial treatment with a heater probe. In pilot studies at laparotomy, primary and adjunctive cyanoacrylate therapy of 81 bleeding ulcers were evaluated in seven unheparinized foxhounds. Hemostasis was produced in 11% of ulcers treated with cyanoacrylate alone and in 31% of ulcers treated with cyanoacylate as an adjunctive after partial heater-probe treatment; no sham-treated control ulcers stopped bleeding under the conditions of the experiment. To evaluate Flucrylate (TM) using out standard heparinized ulcer model, a randomized study was performed in six heparinized foxhounds at laparotomy. Ulcers were randomized to treatment with cyanoacrylate alone, adjuctive cyanoacrylate, heater probe alone or untreated control. Sham-treated control ulcers or ulcers treated with cyanoacrylate alone did not stop bleeding; 42% of ulcers treated with cyanoacrylate as an adjunctive stopped bleeding; all ulcers treated with a heater probe stopped bleeding. In this experimental model of acute bleeding gastric ulcer, trifluoroisopropyl 2-cyanoacrylate (Flucrylate(TM),MBR4197) did not stop severe bleeding and was unpredictable as an adjunctive treatment.     

Sclerosant extravasation as a complication of sclerosing endotherapy for bleeding gastric varices

We report here the case of a 65-year-old woman who suffered intraperitoneal sclerosant leakage after endoscopic injection sclerotherapy for bleeding gastric varices. In total, 3 ml of N-butyl-2-cyanoacrylate and Lipiodol mixture was injected. The patient developed mild fever and pain over the left upper quadrant and flank after the procedure. In addition to a Lipiodol-filled gastric varix, the imaging studies disclosed a wide spread of Lipiodol over the left peritoneal cavity. The patient was kept fasting with parenteral antibiotics and nutrition. She responded well to the treatment, and all of the symptoms had subsided 6 days later.     

三腔二囊管与内镜联合治疗食管胃底静脉曲张破裂出血

目的探讨三腔二囊管与内镜联合治疗食管胃底静脉曲张破裂出血的疗效,及三腔二囊管压迫止血后,内镜介入时机的选择。方法 87例食管胃底静脉曲张破裂出血患者,随机分为2组,观察组：三腔二囊管压迫后,胃管抽出胃液提示无明显活动性出血,患者生命体征平稳后,即行内镜下曲张静脉治疗;对照组：传统方法三腔二囊管压迫止血（即：三腔二囊管气囊压迫止血,每8~12 h放松气囊1次,出血停止24~48 h后,先放出气囊空气,再观察24 h,如无再出血则拔管）,再行内镜治疗。结果两组患者均顺利完成了内镜下治疗,未因活动性出血或胃腔积血影响内镜操作或治疗效果。但观察组缩短了既往三腔二囊管压迫至内镜治疗的间隙期,减轻了患者痛苦,减少了气囊压迫并发症,避免了观察期内反复出血而延误内镜治疗时机,乃至死亡的可能。结论三腔二囊管与内镜联合治疗食管胃底静脉曲张破裂出血疗效佳,观察组内镜治疗的时机,兼具了内镜急诊止血与择期治疗预防再出血的优点,值得推广。