硬化剂与组织粘合剂联合注射治疗活动性食管胃静脉曲张大出血

目的探讨硬化剂与组织粘合剂联合注射治疗活动性食管胃静脉曲张大出血的急诊疗效,总结内镜下联合注射治疗的临床经验。方法回顾分析5例食管胃静脉曲张活动性大出血患者的急诊内镜下硬化剂联合组织粘合剂注射治疗的临床特点,对静脉曲张内镜下表现、联合治疗时机、治疗方法及疗效进行分析。结果内镜下经硬化剂与组织粘合剂联合注射治疗后均达到即刻止血效果,止血成功率100%。随访6~24个月,其中1例经再次治疗后随访至24个月未见出血;其余4例随访无再出血发生。结论硬化剂与组织粘合剂联合注射治疗活动性食管胃静脉曲张大出血是一种安全、有效的方法,其近期及远期疗效可靠,值得临床推广。     

高位食管静脉曲张破裂出血患者内镜诊治经验:10年单中心回顾性分析

目的 探索高位食管静脉曲张破裂出血(SEVB)患者内镜诊治特点及预后。方法 2010年1月～2020年1月哈尔滨医科大学附属第二医院内镜中心行内镜诊治的食管胃静脉曲张(GEV)患者25539例,其中SEVB者12例(0.4‰),其中采用急诊内镜下止血5例,非急诊内镜下止血7例。结果 12例SEVB患者中,乙型肝炎肝硬化5例,丙型肝炎肝硬化4例,酒精性肝炎肝硬化2例,不明原因性肝硬化1例;11例有明显的呕血、黑便、便血或周围循环障碍临床表现;5例急诊内镜下即时止血均成功,7例非急诊内镜下即时止血成功6例,无统计学差异(P>0.05);9例单用食管静脉曲张套扎术(EVL)治疗,其他采取硬化剂注射、EVL联合组织胶注射、EVL联合硬化剂和组织胶注射各1例;术后发生不良反应7例;随访8例患者(31.0±28.5)个月,近期再出血1例,远期再出血5例。在7例全程随访患者中,择期行脾切除术者1例,脾切除术联合贲门周围血管离断术2例,全因病死率为42.9%。结论 对于SEVB患者多采用EVL治疗,即时止血效果好,但远期预后仍差。术后需联合其他方法治疗以长期控制门脉高压症,降低远期再出血和死亡风险。     

急诊组织胶硬化剂止血术后肝性脑病、肝衰竭1例

胃静脉曲张并出血是门脉高压较为常见的并发症,死亡率比较高[1],常通过药物治疗(包括非选择性β受体阻滞剂、生长抑素等)、镜下治疗(内镜下套扎治疗、曲张静脉组织胶硬化剂注射等)、外科手术及介入等方法治疗和预防[2].目前国内越来越多的医院开始采用"三明治"注射法[3].聚桂醇作为治疗EV 的常用硬化剂,能够增大血管内皮接...     

急诊手术治疗食管胃底静脉曲张破裂出血

目的 总结食管胃底静脉曲张破裂出血急诊手术治疗的经验。方法 对23例食管胃底静脉曲张破裂出血Child A、B级病人行急诊脾切除加贲门胃底周围血管离断术。与同期13例ChildA、B级未行急诊手术治疗进行比较。结果 急诊手术组23例近期无死亡，无再出血。随访1～5年，其中19例无再出血；2例2年后复发食管下段静脉曲张用硬化剂注射治疗治愈，2例3年后因肝功能衰竭死亡。未行急诊手术组13例，其中3例近期反复出血并发肝功能衰竭死亡；7例保守治疗7～9d后无效改手术治疗；3例保守治疗止血，后用硬化剂注射止血。结论 食管胃底静脉曲张破裂出血ChildA、B级宜选择急诊手术治疗，以血吸虫病肝硬化门脉高压效果佳。     

内镜外套管在辅助急诊内镜治疗食管胃静脉曲张出血中的作用研究

目的 探讨内镜外套管在辅助急诊内镜治疗食管胃静脉曲张破裂出血中的作用.方法 选择临床诊断为肝硬化门静脉高压食管胃静脉曲张破裂出血患者62例作为治疗组,采用外套管辅助急诊内镜注射硬化剂治疗.另选择同期行常规急诊内镜治疗的62例食管胃静脉曲张破裂出血患者作对照组,比较两组治疗效果.结果 治疗组62例患者在行急诊内镜止血中先用外套管压迫止血均获成功,止血效率为100%,显著高于对照组的80.65%（P＜0.05） 治疗组食管胃静脉曲张注射后消失率为59.32%显著高于对照组7.27%（P＜0.05）.胸痛和食管溃疡、总住院天数、总医疗费用,治疗组显著低于对照组（P＜0.05）.结论 应用外套管辅助急诊内镜注射硬化剂治疗食管胃静脉曲张出血可提高治疗效率,减少患者负担.     

内镜下聚桂醇治疗食管静脉曲张对门脉高压性胃病的影响

[目的]探讨内镜下聚桂醇治疗食管静脉曲张对门脉高压性胃病(PHG)的影响.[方法]对连续100例门脉高压食管静脉曲张出血后接受内镜下硬化剂聚桂醇治疗的患者开展临床随访研究,评估聚桂醇治疗后对PHG的影响.[结果]注射聚桂醇前33例患者存有PHG(33％);初次注射聚桂醇治疗后PHG患者为74例,其中新增轻度PHG患者41例;2次及以上注射聚桂醇治疗后PHG患者达88例,经注射聚桂醇后PHG发生率明显增高(P＜0.01).注射聚桂醇的次数与PHG的发生相关(P＜0.01).[结论]内镜下硬化剂聚桂醇治疗术(EIS)治疗食管静脉曲张,在控制出血和消退曲张静脉的同时,具有产生和加重PHG的可能,但大多为轻度PHG.患者经硬化剂治疗后控制出血,全身状况好转后应择期手术治疗或长期应用降门脉压药物,控制和改善PHG,预防食管静脉曲张和PHG出血.     

内镜下硬化剂治疗食管静脉曲张破裂出血临床研究

目的观察食管静脉曲张破裂出血内镜下硬化剂治疗的疗效。方法对21例食管静脉曲张破裂出血并进行内镜下硬化剂治疗的患者进行回顾性分析。结果急诊硬化治疗8例,止血成功率87.5%,近期再次出血率12.5%,并发症发生率25%。择期硬化治疗13例,止血成功率92.3%,近期再次出血率8.3%,并发症发生率7.7%。结论内镜下硬化剂注射是食管静脉曲张破裂出血的有效治疗方法,更适合于预防再出血。     

内镜注射联合金属钛夹治疗上消化道动脉喷射状出血的疗效观察

目的 观察内镜下黏膜内注射高渗盐-肾上腺素溶液联合金属止血夹治疗上消化道动脉喷射状出血的效果。方法 1999-07／2004-11共16例病人因呕血和／或黑便接受胃镜检查时发现病灶呈喷射状出血，诊断胃溃疡8例，胃癌1例(溃疡型)，Dieulafoy病5例，胃巨大息肉摘除术后出血2例。全部病例应用内镜下黏膜注射高渗盐-肾上腺素溶液，随后置放金属止血夹。结果 16例应用内镜下黏膜注射高渗盐-肾上腺素溶液联合金属止血夹疗法，均一次止血成功，无一例发生再出血和其它并发症，止血成功率100％。12例病人在6～10周内复查胃镜提示病灶愈合，1例胃癌病人止血后转外科手术治疗。结论 内镜注射联合金属钛夹治疗上消化道动脉喷射状出血止血迅速，疗效可靠，再出血率低，操作简便、安全，具有较高的临床实用价值。     

内镜下微波凝固联合注射治疗急性消化道出血

目的 探讨内镜下微波凝固联合注射治疗急性消化道出血的疗效及安全性。方法 急诊内镜检查急性消化道出血病人20例，其中胃溃疡5例，十二指肠球部溃疡5例，贲门黏膜撕裂3例，胃癌1例，Dieulafoy病3例，大肠血管发育不良2例，大肠海绵状血管瘤1例，内镜下呈喷射性出血4例，涌血16例。内镜下先用注射在出血点周围约0．5cm处多点注射1：10000肾上腺素盐水，每点注射0．5～1ml，至出血停止。再用针状或球状微波辐射器插入或接触出血点及周围组织，用60～70W功率每次1～10秒多次辐射进行凝固，至组织变白肿胀，以巩固止血。结果 20例病人首次治疗均成功止血，48小时内再出血2例，1例为十二指肠球部溃疡病人，再次治疗后血止；1例为Dieulofay病病人，再次出血后转外科手术治疗。未发生一例严重并发症。结论 微波凝固与注射止血法联合应用，可以避免微波治疗急性出血时烧焦血液及组织胶着辐射器影响微波凝固和微波探头粘连组织导致撕裂出血，而充分利用注射止血法简单迅速的优点暂时止血，再用微波凝固法巩固治疗，具有止血迅速、对组织损伤小、疗效巩固、安全经济等优点。     

聚桂醇剂量的控制在透明帽辅助内镜下硬化术治疗内痔出血的临床体会

目的 通过控制聚桂醇不同剂量的应用观察透明帽辅助内镜下硬化术(CAES)治疗内痔出血的效果.方法 对入组的60例患者进行CAES治疗内痔出血,控制聚桂醇一点注射的剂量在2 mL内,总结常规或急诊硬化注射治疗的止血疗效,近期和远期出现再出血的情况,以及术后和随访期间并发症的观察.结果 60例患者中有24例为急诊内镜下硬化...     

Endoscopic hemostasis for bleeding gastric varices treated by combination of variceal ligation and sclerotherapy with N-butyl-2-cyanoacrylate

Background Bleeding from esophagogastric varices is a serious complication of portal hypertension. The aim of the present study was to determine whether endoscopic sclerotherapy with injection of N-butyl-2-cyanoacrylate combined with variceal ligation was useful for hemostasis of bleeding gastric varices. Methods Twenty-seven patients with bleeding gastric varices underwent endoscopic treatment with variceal ligation followed by sclerotherapy with N-butyl-2-cyanoacrylate from November 1995 to November 2000. Patients underwent endoscopic variceal ligation only for the bleeding spot just before sclerotherapy. Injection was continued until varices were engorged. After these therapies, patients were followed for at least for 5 years. Retreatment was applied as necessary. Results Among these patients, 11 had active bleeding and 16 had recent bleeding within 24 h with white or red plaques on gastric varices. All varices presented as nodular or tumorous forms. The hemostasis rate at 1 week after treatment with N-butyl-2-cyanoacrylate was 88.9% (24/27). Among the patients achieving hemostasis at 1 week, 33.3% (8/24) experienced recurrent bleeding between 5 and 53 months after the initial treatment. Five patients with rebleeding were treated with N-butyl-2-cyanoacrylate, and the other three patients were treated by other procedures. The final hemostasis rate was 81.5% (22/27). The 5-year survival rate after initial hemostasis was 63.0% (17/27). Conclusions This study showed that endoscopic variceal ligation combined with sclerotherapy might become a recommended choice for effective treatment of bleeding gastric varices.     

胃镜下聚桂醇注射治疗肝硬化并发食管静脉曲张患者临床疗效研究

目的 探讨在胃内镜下聚桂醇注射治疗肝硬化并发食管静脉曲张患者的临床疗效及安全性。方法 2016年1月~2017年12月在我院行内镜下硬化治疗的肝硬化并发食管静脉曲张患者80例,其中38例接受内镜下注射聚桂醇治疗,另42例接受内镜下注射鱼肝油酸钠治疗,随访12个月。结果 注射聚桂醇组显效和有效率分别为65.8%和26.3%,与注射鱼肝油酸钠组的69.0%和26.2%比,差异无统计学意义（P>0.05）;注射聚桂醇组急诊止血成功率和再出血发生率分别为92.1%和34.2%,与注射鱼肝油酸钠组的95.2%和31.0%比,差异均无统计学意义（P>0.05）;注射聚桂醇组术后发热、胸痛、溃疡和食管狭窄发生率分别为13.2%、13.2%、10.5%和2.6%,均明显低于注射鱼肝油酸钠组（分别为33.3%、38.1%、42.9%和19.1%,P<0.05）;在随访3个月、6个月和12个月时,注射聚桂醇组曲张静脉复发率分别为10.53%、18.42%和28.95%,与注射鱼肝油酸钠组的9.52%、14.29%和30.95%比差异无统计学意义（P>0.05）。结论 在胃内镜下注射聚桂醇治疗肝硬化并发食管静脉曲张患者止血成功率高,疗效确切,且术后并发症发生率较低,是一种安全有效的治疗方法。     

Efficacy of endoscopic therapy for gastrointestinal bleeding from Dieulafoy's lesion

AIM: To investigate the endoscopic hemostasis for gastrointestinal bleeding due to Dieulafoy’s lesion.METHODS: One hundred and seven patients with gastrointestinal bleeding due to Dieulafoy’s lesion were treated with three endoscopic hemostasis methods: aethoxysklerol injection (46 cases), endoscopic hemoclip hemostasis (31 cases), and a combination of hemoclip hemostasis with aethoxysklerol injection (30 cases).RESULTS: The rates of successful hemostasis using the three methods were 71.7% (33/46), 77.4% (24/31) and 96.7% (29/30), respectively, with significant differences between the methods (P < 0.05). Among those who had unsuccessful treatment with aethoxysklerol injection, 13 were treated with hemoclip hemostasis and 4 underwent surgical operation; 9 cases were successful in the injection therapy. Among the cases with unsuccessful treatment with hemoclip hemostasis, 7 were treated with injection of aethoxysklerol and 3 cases underwent surgical operation; 4 cases were successful in the treatment with hemoclip hemostasis. Only 1 case had unsuccessful treatment with a combined therapy of hemoclip hemostasis and aethoxysklerol injection, and surgery was then performed. No serious complications of perforation occurred in the patients whose bleeding was treated with the endoscopic hemostasis, and no re-bleeding was found during a 1-year follow-up.CONCLUSION: The combined therapy of hemoclip hemostasis with aethoxysklerol injection is the most effective method for gastrointestinal bleeding due to Dieulafoy’s lesion.     

Endoscopic injection sclerosis: effective treatment for bleeding peptic ulcer.

One hundred and nine patients presenting with severe haemorrhage from benign peptic ulcers were randomised to either endoscopic injection sclerotherapy using a combination of 1:100,000 adrenaline and 5% ethanolamine or to conservative treatment. Only high risk patients with active bleeding or endoscopic stigmata of recent haemorrhage and accessible ulcers were considered. The two groups were well matched for age, shock, haemoglobin concentration, endoscopic findings, and consumption of non-steroidal anti-inflammatory drugs. The group treated endoscopically had a significantly reduced rebleeding rate (12.5% v 47%, p less than 0.001). Rebleeding was successfully treated in some patients by injection sclerotherapy, other patients underwent urgent surgery. While there was a tendency towards a lower operation rate and lower transfusion requirements in the treated group, this failed to achieve statistical significance. The use of injection sclerotherapy in the conservatively treated group after rebleeding undoubtedly reduced the number of surgical operations. Endoscopic injection sclerotherapy is effective in the prevention of rebleeding in these patients.     

预注硬化剂减少组织胶治疗后胃静脉曲张早期排胶出血

目的通过先注射硬化剂、再注射组织胶的方法治疗胃静脉曲张,观察是否能降低早期排胶出血率。 方法回顾性分析2014年1月至2018年3月经解放军火箭军总医院消化内镜中心因食管胃静脉曲张接受内镜下组织胶注射治疗的274例患者,将患者分成二组：改良方法组(组织胶注射灌注硬化剂)14例;传统方法组(单纯注射组织胶)133例。改良方法组注射组织胶前预注硬化剂3～5 ml。观察两组早期排胶再出血发生情况的差异。 结果传统方法组133例患者中发生早期排胶再出血9例,再出血率6.8%;改良方法组141例患者中发生早期排胶再出血2例,再出血率1.4%,较传统方法再出血率降低(P＝0.031)。 结论在胃静脉曲张患者内镜治疗中,改良方法组预注硬化剂比传统方法组织胶注射治疗具有更低的早期排胶再出血率。     

New techniques: combined endoscopic injection sclerotherapy and ligation for acute bleeding from gastric varices

BACKGROUND/AIMS: Combined endoscopic injection sclerotherapy and endoscopic variceal ligation was used for the treatment of acute bleeding from gastric varices. METHODOLOGY: Between July 1995 and August 1998, three cirrhotic patients with acute bleeding from gastric varices were treated. Endoscopic variceal ligation of the puncture point and bleeding point was performed simultaneously. RESULTS: Acute bleeding from the gastric varices was successfully stopped in all cases. CONCLUSIONS: Combined endoscopic injection sclerotherapy and endoscopic variceal ligation can be used to stop bleeding and prevent rebleeding from gastric varices.     

A clinical controlled trial of endoscopic sclerotherapy for repeated esophageal variceal bleeding

Thirty-seven patients with postnecrotic cirrhosis of the liver and 13 patients with primary hepatoma were proven to have repeated bleeding from ruptured esophageal varices. Clinically controlled trials were performed by assigning patients to either sclerotherapy or control arms (25 patients each). Combined intra-variceal and para-variceal injection before an upper endoscopic examination was performed in the sclerotherapy group. In all 25 sclerotherapy cases (100%) hemostasis was successful, which was a statistically significant success rate compared to the control group (52.0%) (p less than 0.01). In the sclerotherapy group 20% (5/25 cases) developed rebleeding, which was less than the 48.0% (7 cases of continuous bleeding and 5 cases of rebleeding) of the control group (p less than 0.05). Four cases (16.0%) in the sclerotherapy group died of erosive gastritis with massive bleeding, compared to 8 fatalities (32.0%) in the control group, because of uncontrolled esophageal variceal bleeding. Endoscopic sclerotherapy is a very effective method for arresting bleeding esophageal varices, and for decreasing the rebleeding rate.     

合并胃肾或脾肾分流道的胃静脉曲张内镜下联合注射治疗

目的探讨胃静脉曲张(GV)合并胃肾或脾肾分流道(SGRS或SSRS)患者经内镜下硬化剂联合组织黏合剂注射治疗的效果。方法选取解放军总医院2008年6月-2013年6月收治的经胃镜及CT检查证实为存在SGRS或SSRS的17例GV患者的临床资料进行回顾性研究,并对内镜下胃静脉曲张硬化剂联合组织黏合剂注射治疗效果进行初步分析。结果 17例患者均因间断呕血、黑便入院。乙肝肝硬化9例,乙肝合并原发性肝癌2例,酒精性肝硬化2例,隐源性肝硬化1例,门脉海绵样变1例,结肠癌术后门静脉系统血栓1例,Wilson氏病1例。胃静脉曲张分型GOV-1型2例,GOV-2型11例,IGV-1型4例,无IGV-2型。胃肾分流道13例,脾肾4例。17例患者均行内镜下硬化剂联合组织黏合剂注射治疗,术后无异位栓塞等并发症发生。结论合并SGRS或SSRS的GV,经内镜下硬化剂联合组织黏合剂注射治疗,在有效治疗GV同时也可最大限度地降低组织黏合剂固化物经分流道致异位栓塞发生的可能性。治疗前应行胃镜及门静脉CT血管成像检查,直观了解胃底静脉曲张情况及其交通支、分流道情况。     

The treatment of gastric fundal varices--endoscopic therapy versus interventional radiology

BACKGROUND/AIMS: Balloon-occluded retrograde transvenous obliteration is an effective method for treating gastric fundal varices. The present retrospective study was performed to determine the clinical efficacy for gastric fundal varices associated with endoscopic therapy, surgery, and interventional radiology including balloon-occluded retrograde transvenous obliteration. METHODOLOGY: We classified 26 patients to a surgery group, an endoscopic therapy group, and an interventional radiology group according to initial treatment and subsequent treatment, and we compared the rates of hemostasis, eradication, and bleeding in these groups. RESULTS: Interventional radiology was successful in arresting acute hemorrhage in 100% of cases, while endoscopic therapy was successful in only 50% of cases. The rate of eradication was 100% in the Surgery group, 66.7% in the Endoscopic Therapy group, and 50% in the Interventional Radiology group. The cumulative bleeding rate at 5 years was 0% in the Surgery group, 0% in the Endoscopic therapy group, and 11.1% in the Interventional Radiology group. No significant difference was observed between the three groups. CONCLUSIONS: The treatment-of-choice for gastric fundal variceal hemorrhage is endoscopic injection sclerotherapy and ligation, with interventional radiology as the back-up procedure in case endoscopic injection sclerotherapy and ligation is unsuccessful. Interventional radiology is the treatment-of-choice for elective treatment of gastric fundal varices.