“球体体积公式”估算组织胶用量应用于内镜下组织胶注射术治疗胃静脉曲张的临床研究

Application of spherical volume formula in estimating the amount of cyanoacrylate glue in endoscopic cyanoacrylate glue injection for gastric varices

目的探讨"球体体积公式"估算单根血管组织胶用量应用于内镜下组织胶注射术治疗胃静脉曲张(GV)的效果及安全性。方法按照相关标准纳入研究对象,回顾性分析河南省人民医院2018年12月至2022年6月因GV首次接受内镜下组织胶注射治疗的23例患者的临床资料,所有患者术前均通过腹部增强CT结合胃镜评估GV单根血管最大直径,并应用"球体体积公式"估算单根血管用胶量,短期疗效的观察包括技术成功率、拔针出血率、溢胶率、增强CT下静脉曲张团消失率、术后5 d再出血率、早期(术后6周)再出血率,远期疗效的观察包括排胶出血率、迟发性再出血率、1年再出血率、1年死亡率,统计异位栓塞发生率以评价手术的安全性。结果23例患者内镜下组织胶注射术成功率为100%(23/23),总用胶量为(3.8±2.4)ml,拔针出血率、溢胶率均为0,增强CT下胃静脉曲张团消失率为4.3%(1/23)。术后5 d再出血率及早期再出血率均为0。无异位栓塞发生。术后成功随访22例患者,随访成功率为95.7%(22/23),随访时间(24.1±13.0)个月。随访期间,无一例患者发生排胶出血。迟发性再出血率及术后1年再出血率均为4.5%(2/22);术后1年内病死率为13.6%(3/22),其中1例与出血有关。结论"球体体积公式"估算单根最大血管用胶量应用于内镜下组织胶注射术治疗GV安全有效,可达到精确用胶目的,其远期疗效及安全性仍有待进一步研究证实。

Objective To investigate the efficacy and safety of estimating the amount of cyanoacrylate glue in a single vessel according to sphere volume formula in endoscopic cyanoacrylate glue injection for gastric varices(GV).Methods Subjects were included in the study according to the relevant standards,the data of 23 patients who received endoscopic cyanoacrylate glue injection for GV for the first time in Henan Provincial People’s Hospital from December 2018 to June 2022 were retrospectively analyzed.The maximum diameter of single GV vessel in all patients were evaluated by abdominal enhanced computed tomography(CT)combined with gastroscope before operation,and the amount of glue used for a single vessel was estimated according to the sphere volume formula.The short-term curative effect was assessed by technical success rate,bleeding rate after needle extraction,glue overflow rate,disappearance rate of gastric varicose under enhanced CT,rebleeding rate 5 days after operation,early phase(6 weeks after operation)rebleeding rate.The long-term curative effect was assessed by rate of bleeding after glue drainage,delayed rebleeding rate,rate of rebleeding in 1 year after operation,1-year case fatality rate.The incidence of ectopic embolism was counted to evaluate the safety of the operation.Results The success rate of endoscopic cyanoacrylate glue injection in 23 patients was 100%(23/23);the total amount of glue used was(3.8±2.4)ml;the bleeding rate after needle extraction and the glue overflow rate both were 0;the disappearance rate of gastric varicose under enhanced CT was 4.3%(1/23).Both rebleeding rate 5 days after operation and early phase rebleeding rate were 0.No ectopic embolism occurred.Twenty-two patients were followed up successfully after operation,the success rate of follow-up was 95.7%(22/23),and the follow-up time was(24.1±13.0)months.During the follow-up period,no one patient suffered from bleeding after glue drainage.The rate of delayed rebleeding and the rate of rebleeding in 1 year after operation both were 4.5%(2/22),and the 1-year case fatality rate was 13.6%(3/22),and 1 case death was related to bleeding.Conclusions It is safe and effective to use the sphere volume formula to estimate the maximum amount of glue used for a single vessel in the endoscopic cyanoacrylate glue injection for GV,and the method can achieve the purpose of precise glue use.Its long-term efficacy and safety still need to be confirmed by further research.