内镜套扎联合注射组织粘合剂治疗食管胃底静脉曲张破裂出血46例的临床分析

Clinical Analysis on Ruptured Hemorrhage of Varices of Fundus of Stomach and Esophagus Treated by the Endoscopic Variceal Ligation Combining with the Injection of Histoacryl

目的：探讨内镜下套扎并联合注射粘合剂治疗食管胃底静脉曲张破裂出血的临床疗效。方法：经内镜下连续套扎术治疗食管胃底静脉曲张破裂出血46例，及经过套扎术后诱发加重的8例胃底静脉曲张破裂出血者联合内镜下组织粘合剂注射治疗的临床资料进行回顾性分析。结果：46例套扎治疗者，平均每套扎2．1次，共进行87例次386处套扎，显效32例（69．5％），有效12例（26．2％），其中2例并发大出血失败（4．3％），总有效率（95．7％），8例患者分别于食管静脉曲张套扎术后第4～12周出现Ⅳ—Ⅴ级胃底静脉曲张（发生率17．4％），经联合注射组织粘合剂治疗后静脉曲张消失，6个月后胃镜复查组织粘合荆完全排出，未再出血。结论：内镜套扎治疗食管静脉曲张破裂出血疗效显薯．对奎扎术后请发加重胃底静脉曲张破裂出血．联合镜下组织粘合剂注射获得满意疗效．

Objective： To probe into the clinical efficacy of the ruptured hemorrhage of varices of fundus of stomach and esophagus （ RHVFSE ） treated by the endoscopic variceal ligaton （ EVL ） combining with the injection of histoacryl. Method： The retrospective analysis was made on the clinical materials concerning 46 cases of RHVFSE patients treated by the continuous EVL and 8 cases of patients who had ruptured hemorrhage of varices of fundus of stomach and was more serious after the EVL. Result： For 46 EVL cases, it was 2.1 times each case and 386 ligations for 87 case/times, 32 cases produced effect （69.5% ）, 12 cases were effective （ 26.2% ） and 2 cases were failed due to the complication of massive hemorrhage with the effective rate being 95.7%. Among them, there were 8 cases had Ⅳ - Ⅴ Grade varices of fundus of stomach after 4 = 12 weeks of EVL with the incidence being 17.4%. The varices of fundus of stomach disappeared after injec- ting the histoacryl and the histoacryl was drained out after 6 months without haemorrage any more. Conclusion： The efficacy of ruptured hemorrhage of esophagus varices treated by EVL is obvious and for the ruptured hemorrhage of varices of fundus of stomach induced by EVL, the efficacy will be satisfactory if combining with the injection of histoacryl.