改良单囊三腔管压迫下内镜硬化治疗时拉拔三腔管致食管穿孔的治疗

我院消化内科于2001年3月,对1例乙型肝炎后肝硬化合并食管静脉曲张破裂出血患者行去除食道囊的改良单囊三腔管压迫,内镜下硬化治疗。操作中因患者自己强行拉拔三腔管而导致食管穿孔,后经我科及时全力抢救而脱险,现报告如下。 临床资料:男,31岁,因反复乏力、纳差4年,呕血、黑便1d入院。原有乙型肝炎病史5年,4年前在外院诊断为“肝炎后肝硬化”。入院后诊断为“食管胃底静脉曲张破裂     

单囊三腔管压迫下硬化剂注射治疗食管静脉曲张出血的护理

肝硬化合并食管静脉曲张出血对生命有极大的威胁。首次出血病死率高达40％～80％。为了降低病人的病死率，1998-02／2002-01，我科对36例食管静脉出血病人用单囊三腔管压迫加胃镜下硬化剂注射止血治疗，取得了较好的效果，现将护理情况报告如下。     

7例三腔二囊管压迫止血并发胃气囊破裂的原因分析

三腔二囊管压迫止血是治疗食管胃底静脉曲张破裂出血的重要措施[1],但三腔二囊管压迫止血是一项侵入性操作,在应用过程如果发生胃气囊破裂可能会危及到患者的生命,如何减少胃气囊破裂的发生,一直受到医护人员的关注.2009-01 - 2011-12月期间本院为46例食管胃底静脉曲张破裂出血患者实施三腔二囊管压迫止血治疗,其中有7例发生胃气囊破裂,现将原因分析和护理对策报告如下.     

食管胃底静脉曲张出血病人三腔二囊管简便牵引法止血效果观察

在对食管胃底静脉曲张破裂出血病人使用三腔二囊管止血时,为牵引简便,我科参照其他医院的经验,在临床实践中摸索总结出一种简便牵引固定法.该方法既能达到牵引胃囊止血的目的,又减少了病人的痛苦,并大大地方便了医务人员的诊疗,现介绍如下.     

食管胃底静脉曲张破裂出血病人拒绝三腔双囊管压迫止血的原因分析及干预

三腔双囊管压迫止血仍为治疗门脉高压食管胃底静脉曲张破裂出血最有效的方法．但由于插管给病人带来的巨大痛苦。病人接受程度低，心理负担重。为最大限度地减轻病人的痛苦与不适，增加止血效果，我科对2002-01／2004-12食管胃底静脉曲张破裂出血拒绝插三腔管的28例病人进行了调查分析。同时通过角色换位思考、健康指导等方法，提出一系列有效的护理措施，使病人愿意接受三腔双囊管治疗，取得了肯定的效果，现介绍如下。     

三腔二囊管压迫与内镜下食管静脉曲张套扎术联合治疗食管静脉曲张出血的疗效观察

[目的]观察三腔二囊管压迫与内镜下食管静脉曲张套扎术(EVL)联合治疗食管静脉曲张出血的疗效。[方法]回顾性总结289例食管静脉曲张出血的患者行EVL治疗的结果,其中176例活动性出血的患者EVL前行三腔二囊管压迫止血术。EVL后2周内再发出血患者行内镜引导下三腔二囊管置入术,控制出血后再次行胃镜检查,必要时再次EVL治疗。[结果]EVL前三腔二囊管压迫止血有效率为95.46%(168/176),首次内镜下食管静脉曲张套扎治疗有效率为96.19%(278/289)。11例EVL后2周内发生再出血患者,行内镜引导下三腔二囊管置入及压迫术,其中9例压迫成功;5例再次行EVL治疗后控制出血。三腔二囊管压迫与EVL联合治疗食管静脉曲张出血的总有效率为99.31%(287/289)。[结论]三腔二囊管与EVL联合治疗食管静脉曲张出血,可以提高EVL的总有效率。     

三腔两囊管在食管胃静脉曲张大出血院前急救中的应用

目的探讨院前应用三腔两囊管救治食管胃静脉曲张大出血的可行性及疗效。方法回顾性分析秦皇岛市第一医院2011年1月至2014年1月院前接诊的食管胃静脉曲张大出血患者86例,随机分为两组,对照组44例,给予垂体后叶素等常规治疗;三腔管组42例,常规治疗基础上紧急行三腔两囊管压迫止血。两组入院后药物治疗相同,比较两组临床疗效。结果三腔管组止血成功37例,占88.10%,对照组止血成功37例,占84.09%,两组比较,差异无统计学意义(P0.05);三腔管组平均止血时间、治疗后出血量、输血量、住院天数均明显优于对照组,差异有统计学意义(P0.05);三腔管组不良反应发生率为81.0%高于对照组的22.7%,差异有统计学意义(P0.01)。结论三腔两囊管紧急止血迅速有效,适用于院前急救,但应严格掌握适应证。     

三腔两囊管的应用现状

<正>随着医学科技的飞速发展,临床上对食管、胃底静脉曲张破裂出血的治疗也愈来愈多样化,主要包括新型药物治疗、急诊外科手术、食管胃底曲张静脉栓塞术、胃镜下曲张静脉套扎术、组织胶注射、球囊血管成形术~(〔1~5〕),其病死率明显降低~(〔6,7〕)。但绝大多数医院不具备内镜下治疗或X线下介入治疗相应条件,即便具备以上提及条件,治疗失败后有时可能仍然需要采取三腔两囊管压迫治疗。尤其在肝硬化门静脉高压引起食管     

三腔二囊管插入方法的改良

195 0年Ｓｅｎｇｓｔａｋｅｎ及Ｂｌａｋｅｍｏｒｅ创用三腔二囊管[1] 。半个世纪以来三腔二囊管压迫止血一直是治疗食管静脉曲张出血的首选方法[2 ] 。近年来 ,多数国外专家提倡用于紧急时暂时性止血 ,作为其他介入治疗的术前应用 ,止血率可达95 % [3 ] 。但在临床中由于三腔二囊管管身软 ,病人病重不能配合 ,操作者不熟练等原因致使部分病人插管失败。我们发现将沙氏导丝 (Ｓａｖａｒｙ Ｇｉｌｌｉａｒｄｗｉｒｅｇｕｉｄｅ)插入三腔二囊胃导管内 ,通过提高导管的硬度可以顺利插管 (简称改良法 )。一、材料与方法1.研究对象 :用传统方法一…     

Endoscopic sclerotherapy of esophageal varices during pregnancy--case report

Variceal hemorrhage in a patient with non cirrhotic portal hypertension occurring in mid pregnancy was treated by endoscopic intravasal injection sclerotherapy using polidocanol. It was effective, well tolerated and safe for both mother and child. This is the first report that this treatment is feasible and without risk in pregnancy.     

Venography during endoscopic injection sclerotherapy of esophageal varices

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.     

Obliteration of esophageal varices using EUS-guided sclerotherapy with color Doppler

BACKGROUND: The current standard treatment of bleeding esophageal varices is band ligation. Although endoscopic sclerotherapy has largely been supplanted by band ligation, there are still clinical situations in which injection methods are useful. Endoscopic ultrasound (EUS) may allow for a more complete evaluation of esophageal varices and perforating veins and may allow for more effective delivery of sclerosant. Our aim was to evaluate the use of color Doppler EUS-guided sclerotherapy for the obliteration of esophageal varices. METHODS: Five patients with esophageal varices (Child's A = 1, B = 2, C = 2) underwent dynamic EUS-guided sclerotherapy with color flow Doppler. EUS sclerotherapy was performed using Varijet (2.5 mm catheter) injector needles and sodium morrhuate directed at the perforating vessels until flow was completely impeded (2 to 4 mL per injection site). Data collected included (1) sessions to obliteration, (2) episodes of recurrent bleeding, (3) complications, and (4) mortality. RESULTS: Patients undergoing EUS-sclerotherapy required 2.2 sessions to achieve obliteration of varices. No patient had a recurrence of bleeding and no deaths occurred. One patient developed an esophageal stricture that responded to balloon dilation. CONCLUSIONS: Dynamic EUS-guided sclerotherapy with color flow Doppler may be safely and effectively used for the treatment of esophageal varices. It allows for effective delivery of sclerosant with favorable outcomes. Prospective, multicenter, randomized trials are warranted.     

Balloon catheter-assisted endoscopic sclerotherapy for gastric fundal varices using alpha-cyanoacrylate monomer

We present two patients with bleeding episodes from gastric fundal varices. The gastric fundal varices were treated by balloon catheter-assisted endoscopic sclerotherapy using alpha-cyanoacrylate monomer. The varices were successfully obliterated with no complications or hemodynamic changes to the gastrorenal shunts. This procedure may be considered a novel, feasible approach to the treatment of gastric fundal varices in the future.     

Changes of blood gas during endoscopic injection sclerotherapy of esophageal varices

To assess the mechanism of arterial hypoxia after endoscopic injection sclerotherapy (EIS) for esophageal varices, blood gas analysis was carried out in 38 patients with hepatic cirrhosis. The partial pressure of oxygen in arterial blood (Pa_o2) was decreased more than 15 torr after EIS in 12 (21 %) of 56 sessions of intravariceal injection and in three (16%) of 20 sessions of the paravariceal injection. When blood gas analysis was performed at 30 min after premedication (before EIS) in six patients in whom Pa_O2 decreased more than 15 torr, the decrease of Pa_o2 and increase of alveolar-arterial partial pressure of oxygen difference (AaD_o2) were identified in all of them already before EIS. These data indicate that arterial hypoxemia after EIS may be the result of not only the direct effect of sclerosant, but also premedication for EIS.     

食管静脉曲张破裂大出血的急诊硬化治疗

目的 总结食管静脉曲张破裂大出血极危重患者在急诊内镜下行硬化治疗(EIS)的经验。方法 176例食管静脉曲张破裂大出血患者在改良三腔管牵引下，共用5%鱼肝油酸钠食管静脉内注射209次，其中181次为致死性活动性大出血。结果 首次EIS能明确出血部位166例(94．3%)，急诊EIS止血成功201次(96．2％)，其中21例为多次EIS后止血，并发症15例(8．5％)，死亡3例(1．7％)。结论 改良三腔管牵引下行EIS是急诊救治致死性食管静脉曲张大出血的安全、有效、简便方法。     

Oesophageal varices treated by sclerotherapy: a histopathological study.

Of 31 cases of haemorrhage from oesophageal varices treated by sclerotherapy eight came to necropsy. The oesophagus and proximal stomach were studied by means of a serial block technique and the histopathological findings in each case were recorded on two full-scale maps: one representing superficial tissues including the submucosa and the other the deeper tissues. The patterns of thrombosis, ulceration, necrosis, and fibrosis were studied in relation to the time interval since injection. Thrombosis and tissue necrosis were present within 24 hours of sclerotherapy, ulceration after seven days, and fibrosis after a month. Fibrosis was sometimes associated with stricture formation, which readily responded to dilatation. Patients with fibrosis had a reduced incidence of rebleeding.