经内镜注射组织黏合剂D-TH胶治疗胃静脉曲张出血的探讨

Gastric varices bleeding treated by tissue adhesive, D-TH glue injection

目的 探讨组织黏合剂D-TH胶治疗胃静脉曲张(GV)出血的价值。方法 内镜下用三明治夹心法注射D-TH胶治疗GV 59例,46例GV出血,其中37例急性出血,9例近期出血;13例无GV出血史。随访观察其疗效及并发症。结果 59例患者共注射96次,平均1.63次／例,每点注射1ml。37例GV急性出血患者,急诊止血率为100％,30例(65.2％)随访12-36个月,平均(24.9±11.7)个月,3个月再出血率6.7％(2／30),12个月再出血率16.7％(5／30),36个月再出血8例,生存率为86.5％。术后发热2例,无其他并发症发生。结论 经内镜注射D-TH胶治疗GV出血是一种安全、有效的方法。

Objective To study on gastric varices bleeding treated by tissue adhesive, D-TH glue injection. Methods Fifty-nine consecutive cirrhotic patients with gastric varices were undergone endoscopic D-TH glue injection with sandwich approach. Among these 59 patients, bleeding was present in 46 patients (acute bleeding in 37, recent bleeding in 9) , no previous of gastric variceal bleeding in 13. Follow-up study on therapeutic results and complications were conducted. Results Ninety-six injections were performed in all patients with a mean of 1. 63 injections (1-2ml) per patient. Recurrent bleeding never occurred in 37 patients with acute gastric varices bleeding 72 hours after injection, and the rale of emergency endoscopic he mostasis was 100 per cent. Thirty (65. 2% ) of 46 patients with bleeding gastric varices were followed for 12 36 months, 24. 9 months on average. Recurrence of bleeding occurred in 2(6. 7% ) , 5 ( 16. 7% ) and 8 (26. 7% ) cases at 3 , 12, and 36 months respectively. The rate of survival was 86. 5 per cent. Besides fever occurred postoperatively in 2 cases, other severe complications never happened. Conclusion Endoscopic D-TH glue injection is a safe and effective method for treating gastric varices bleeding.