经内镜注射组织粘合剂联合经皮肝门静脉栓塞治疗食管胃底静脉曲张出血临床研究

目的评价内镜下注射组织粘合剂(histoacryl)与内镜下注射组织粘合剂联合经皮肝穿胃冠状静脉栓塞治疗胃底食管静脉曲张两种治疗方法的疗效。方法对57例食管胃静脉曲张患者分别进行内镜下注射组织粘合剂(单纯组38例)与内镜下注射组织粘合剂联合经皮肝穿胃冠状静脉栓塞(联合组19例)两种治疗方法的比较。术后随访止血率、再出血发生率、曲张静脉曲张消失率、并发症发生率等指标。结果联合组急诊治疗11例,择期治疗8例,随访2～24个月,平均12.2个月;近期再发出血1例,>6个月再发出血2例,分别为5.3%和10.5%;术后死亡1例,死于术后近期肝、肾功能衰竭;术后3～6个月行食管钡餐检查,食管静脉曲张消失或基本消失13例(68.4%),明显好转6例。单纯组急诊注射16例,择期治疗22例,随访2～16个月,平均11.8个月;近期再出血7例,>6个月再发出血12例,分别占18.4%和31.6%;术后死亡3例,1例死于术后近期肝、肾功能衰竭,1例于术后4个月死于肝癌,1例手术后8个月死于上消化道大出血;术后3～6个月行食管钡餐检查,食管静脉曲张消失或基本消失16例(42.1%),明显好转22例。结论联合治疗组比单纯内镜下治疗有效率高、重复性少、安全性好、近期复发再出血发生率低,是一较安全、有效的方法。

Treatment of esophagogastric varices by combine of endoscopic injection of tissue gluetotreat and percutaneous transhepatic embolization

Objective] To compare the efficacy of endoscopic injection of cyanoacrylate as the sole treatment and combine with percutaneous transhepatic embolization for esophagogastric varices(EV).Methods] 19 of Fifty-seven patients(A group)were treated by combined endoscopic injection and PTVE,38 patients(B group)were treated by only endoscopic injection of cyanoacrylate,and the follow-up from 2 to 22 months was carried out in the two groups.Results] The follow-up endoscopy showed that the varices of esophaicgastric disappeared completely 13 of 19 patients(A group 68.4%)and 16 od 38 patients(B group 42.1%)separately,and re-bleeding 2/19(10.5%)and 7/38(27%)separly,It was observed that early rebleeding after group A in 1 cases(5.3%)and late rebleeding occurred in 2 patients(10.5%)at 2~22 months(mean 11.2 months).Group B early rebleeding in 7 cases(18.4%)and late rebleeding occurred in 12 patients(31.7%).And the majority of two groups was 1 and 3 in the follow-up period.Conclusion] Combined treatment group is more effective and safe alternative for EV therapy than only endoscopic tissue adhesive injection.