内镜结扎术在食管静脉曲张出血中的作用

食管静脉曲张出血是门脉高压症最主要的并发症。有慢性肝病的病人 ,其发生率近 3 0 % ,首次出血死亡率高达 3 0 %～5 0 % ,以后复发性出血死亡率为 3 0 % [1] 。静脉曲张急性出血内窥镜技术处理是理想的一线治疗方法 ,也是长期处理预防再出血首选的方法[2 ] 。由于其简单、有效 ,受到广大病人的普遍欢迎 ,因此 ,急诊手术如门奇断流、门体分流已逐渐成为二线治疗方法。内窥镜结扎术 (ｅｎｄｏｓｃｏｐｉｃｖａｒｉｃｅａｌｌｉｇａｔｉｏｎ ,ＥＶＬ)于 1986年问世 ,ＥＶＬ与内窥镜食管静脉曲张硬化疗法 (ｅｎｄｏｓｃｏｐｉｃｉｎｊｅｃｔｉ…     

内镜结扎在治疗静脉曲张出血中的作用

1　食管静脉曲张急性出血的内镜结扎治疗肝硬变食管静脉曲张患者 ,3 4 %死于上消化道出血 ,3 2 %死于肝功能衰竭。因此寻找一种安全、有效的控制出血的方法 ,已成为各国学者关注的焦点。内镜结扎疗法由于其快捷简单、容易操作、并发症少、疗效高 ,正日益受到重视。我们治疗食管静脉曲张破裂出血 88例 ,单环结扎器结扎法止血率为93 .6% ,多环结扎器结扎止血率则更高。对各种治疗方法失败的患者 ,仍然可以取得满意的效果。我们共治疗手术后食管静脉曲张复发出血 79例 ,其中活动性出血 3 8例 ,3 6例经结扎止血 ,紧急止血率为 94.7%。1.1　食管…     

食管胃底静脉曲张出血的内镜诊治

食管胃底静脉曲张出血是指由于各种原因引起的门静脉高压,致使食管和／或胃壁静脉曲张,在压力升高或静脉壁发生损伤时,曲张静脉发生破裂出血,临床上主要表现为上消化道出血和周围循环衰竭征象。食管胃底静脉曲张出血是肝硬化的主要死亡原因,每次出血的病死率达20％～30％,未经治疗的患者1年内因出血致死的几率可达70％。食管胃底静脉曲张出血的病因可见于所有引起门静脉高压的疾病,在我国以肝炎后肝硬化最为常见。     

内镜结扎术治疗手术后食管静脉曲张复发出血65例报告

作者采用经内镜结扎的方法，共治疗手术后食管静脉曲张复发出血６５例．其中活动性出血３１例中有３０例经内镇结扎控制出血，急诊止血率为９７％．经３～５次结扎治疗，５４例食管静脉曲张完全消除或缩小至１°．占８３％．未发生与结扎术有关的严重并发症．该疗法操作简单、安全可靠．对手术后食管静脉曲张复发出血，尤其是肝功能不良者，作者建议首选经内镜结扎术．     

食管和胃底静脉曲张出血的内镜现代治疗

门静脉高压性食管和胃底静脉曲张破裂出血如不及时抢救死亡率很高。内镜治疗是当今预防和控制食管及胃底静脉曲张出血的重要有效方法。 经内镜皮圈结扎治疗     

食管静脉曲张出血的预防和治疗

食管静脉曲张破裂出血是门脉高压症的严重并发症，处理较为复杂，笔者仅针对食管静脉曲张首次出血及再次出血时用药物和内镜法进行预防和治疗，现总结如下。     

应用内镜多环结扎器治疗食管静脉曲张破裂出血30例体会

食管静脉曲张内镜下结扎术（ｅｎｄｏｓｃｏｐｉｃｖａｒｉｃｅａｌｌｉｇａｔｉｏｎ，ＥＶＬ）是近年来国内治疗食管静脉曲张破裂出血的新方法。我院曾采用单环结扎器（ｓｉｇｌｅｂａｎｄｌｉｇａｔｏｒ，ＳＢＬ）行ＥＶＬ治疗患者数百例，疗效显著〔１〕。自１９９６年...     

内镜结扎法治疗食管静脉曲张出血远期疗效

目的：评价内镜食管静脉结扎法治疗食管静脉曲张出血远期疗效。方法：采用内镜食管静脉结扎法治疗263例食管静脉曲张出血病人，每隔2周重复结扎治疗，直至曲张静脉完全闭塞。结果：238例生存期超过3个月的病人中有216例（91％）曲张静脉被根治，曲张静脉的根治需平均结扎治疗4次。全组1、3、5年累积生存率分别是76％、62％、57％。生存率主要取决于肝功能状况。死亡56例（21％），主要死因是肝功能衰竭。再出血主要发生在治疗早期，曲张静脉根治后再出血明显减少。再出血率为15％（39／263）。结论：内镜食管静脉结扎法是治疗食管静脉曲张出血安全有效的方法；重复该法治疗多数情况下可根治曲张静脉，降低再出血率；坚持内镜食管静脉结扎法治疗可减少再出血导致的死亡，延长曲张静脉出血病人的生存期。     

The Evolving Role of Endoscopic Treatment for Bleeding Esophageal Varices

The treatment of acute and recurrent variceal bleeding is best accomplished by a skilled, knowledgeable, and well-equipped team using a multidisciplinary integrated approach. Optimal management should provide the full spectrum of treatment options including pharmacologic therapy, endoscopic treatment, interventional radiologic procedures, surgical shunts, and liver transplantation. Endoscopic therapy with either band ligation or injection sclerotherapy is an integral component of the management of acute variceal bleeding and of the long-term treatment of patients after a variceal bleed. Variceal eradication with endoscopic ligation requires fewer endoscopic treatment sessions and causes substantially less esophageal complications than does injection sclerotherapy. Although the incidence of early gastrointestinal rebleeding is reduced by endoscopic ligation in most studies, there is no overall survival benefit relative to injection sclerotherapy. Simultaneous combined ligation and sclerotherapy confers no advantage over ligation alone. A sequential staged approach with initial endoscopic ligation followed by sclerotherapy when varices are small may prove to be the optimal method of reducing variceal recurrence. Overall, current data demonstrate clear advantages for using ligation in preference to sclerotherapy. Ligation should therefore be considered the endoscopic treatment of choice in the treatment of esophageal varices.     

Long-term Results of Emergency Portacaval Shunt for Bleeding Esophageal Varices in Unselected Patients with Alcoholic Cirrhosis

A prospective evaluation of emergency protacaval shunt has been conducted in 180 unselected, consecutive patients with cirrhosis and bleeding varices who were operated on between 1963 and 1978. An extensive diagnostic work-up was completed within three to seven hours of admission to the emergency department, and the shunt operation was undertaken within a mean of 7.81 hours. A program of lifelong follow-up was conducted such that the current status of 97% of the patients is known. On each patient, 220 categories of data were collected and entered into a computer program for analysis. On admission, 49% of the patients had jaundice, 53% had ascites, 19% had encephalopathy, 30% had severe muscle wasting and 100% had abnormal BSP retention. Administration of a bolus dose of vasopressin by the systemic intravenous route temporarily controlled the varix hemorrhage in 95% of patients, and emergency shunt permanently controlled the bleeding in 98%. Maximum perfusion pressure in the portal vein prior to shunt did not correlate with survival rate or incidence of encephalopathy after shunt. The operative survival rate was 58%, the five-year actuarial survival rate is 38% and the 12-year actuarial survival rate is 30%. Encephalopathy was observed in 31.5% of the patients, but was severe enough to require chronic dietary protein restriction in only 7%. The portacaval shunt remained patent in 99% of patients. Of the survivors, 48% abstained from alcohol, 60% resumed gainful employment or housekeeping, and two-thirds were judged to be in excellent or good condition after one and five years. Preoperative factors that adversely influenced survival rate were ascites, SGOT ≥ 100 units, BSP retention >50%, hypokalemic alkalosis, blood transfusion requirement ≥ 5 L, and consumption of alcohol within seven day[unk] of admission. In comparison with our previous prospective studies, emergency portacaval shunt produced a significantly ġreater long-term survival rate than either emergency medical therapy or emergency varix ligation, followed by elective shunt. During the past four years, 80% of 49 unselected patients have survived emergency shunt, and the four year actuarial survival rate is 69%.     

内镜下食管静脉曲张结扎术后再出血原因分析与护理

对15例内镜下食管静脉曲张结扎术后再出血病人进行回顾性分析.发现结扎后可因溃疡面形成、过早进食、结扎套圈脱落而引发再出血.术后保持正确的体位、严格饮食调整、合理使用药物,可预防术后再出血;严密观察病情,防止咳嗽及恶心、呕吐,进行康复指导,是减少再出血的重要护理措施.     

Octreotide in the Control of Post-Sclerotherapy Bleeding from Oesophageal Varices,Ulcers and Oesophagitis

Bleeding from oesophageal varices, oesophageal ulcers or oesophagitis is occasionally massive and difficult to control. Octreotide, a synthetic analogue of somatostin lowers portal pressure and collateral blood flow including that through varices, increases lower oesophageal sphincter pressure, and inhibits the gastric secretion of acid as well as pepsin. Our current experience suggests it is effective in controlling acute variceal haemorrhage. Therefore we have examined the efficacy of octreotide in the control of postsclerotherapy bleeding from oesophageal varices, oesophageal ulcers and oesophagitis. During the study period 77 patients experienced a significant gastrointestinal bleed (blood pressure < 100 mm Hg, pulse > 100 beats per min or the need to transfuse 2 or more units of blood to restore the haemoglobin level) following injection sclerotherapy of oesophageal varices. The source of bleeding was varices in 42 patients, oesophageal ulcers in 31 and oesophagitis in 4. All patients received a continuous intravenous infusion of octreotide (50 μg/h) for between 40–140h. If bleeding was not controlled in the first 12h after commencing octreotide hourly bolus doses (50 μg) for 24h were superimposed on the continuous infusion. Haemorrhage was successfully controlled by an infusion of octreotide in 38 of the 42 patients with bleeding from varices, in 30 of 31 patients with oesophageal ulceration, and all patients with oesophagitis. In the 1 patient with persistent bleeding from oesophageal ulceration and in 2 of the 4 with continued haemorrhage from varices, haemostasis was achieved by hourly boluses of 50 μg octreotide for 24h in addition to the continuous infusion. No major complications were associated with octreotide administration. The results of this study clearly indicate that octreotide is a safe and effective treatment for the control of severe haemorrhage after technically successful injection sclerotherapy.     

Circular Suture Ligation of Presacral Venous Plexus to Control Presacral Venous Bleeding During Rectal Mobilization

Background

Presacral venous bleeding during rectal mobilization is uncommon but potentially life-threatening. Various methods have been proposed for controlling the bleeding, but each has some obvious limitations in clinical practice. We report a simple technique that was designated as circular suture ligation. This technique was efficient in controlling presacral venous bleeding encountered during rectal mobilization.

Methods

The key point of circular suture ligation was to control the bleeding by suture ligating the venous plexus in one or more circles in the area with intact presacral fascia that surrounds the bleeding site while the bleeding site was temporarily controlled with fingertip pressure. From September 2007 to December 2011, 258 patients underwent rectal surgery in our department because of rectal cancer. Uncontrolled presacral venous bleeding with traditional methods was encountered in eight patients (3 %) with estimated blood loss from 300 to 5,000 ml.

Results

Bleeding was successfully controlled in all eight patients with the circular suture ligation. None of the patients required reoperation for bleeding or other issues. No patients developed chronic pelvic pain after the operation.

Conclusions

Our experience suggests that circular suture ligation of venous plexus in the area with intact presacral fascia that surrounds the bleeding site is an effective and simple technique to control presacral venous bleeding when traditional techniques fail.