组织粘合剂注射联合门静脉栓塞治疗食管胃底静脉曲张出血的临床研究

Treatment of esophagogastric varices by combination of endoscopic injection of tissue adhesive and percutaneous transhepatic embolization

目的评价内镜下注射组织粘合剂联合经皮经肝胃冠状静脉栓塞治疗食管胃底静脉曲张的疗效。方法将57例食管胃静脉曲张患者分为2组,分别进行内镜下组织粘合剂注射(单纯组,38例)和内镜下组织粘合剂注射联合经皮经肝胃冠状静脉栓塞(联合组,19例)治疗。比较2组疗效。结果联合组近期再发出血1例,6个月后再发出血2例,分别占5.3%和10.5%;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。单纯组近期再出血7例,6个月后再发出血12例,分别占18.4%、31.6%;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。结论相对于单纯内镜下组织粘合剂注射治疗,联合经皮经肝胃冠状静脉栓塞术是一种安全有效的治疗食管胃底静脉曲张的方法。

Objective To compare the efficacy of endoscopic injection of cyanoacrylate alone with combination of it and percutaneous transhepatic embolization for esophagogastric varices. Methods 19 of fifty-seven patients（ group A）were treated by combination of endoscopic injection and percutaneous transhepatic variceal embolization, 38 patients （ group B） were treated by only endoscopic injection of cyanoacrylate , and the follow-up of 2 to 22 months was carried out in the two groups. Results The follow-up study with endoscopy showed that the varices of esophaicgastric in 13 of 19 patients（ group A 68.4% ） and 16 of 38 patients（group B 42. 1% ） disappeared completely, It was observed that early rebleeding occurred in 1 cases （5.3%） and late rebleeding occurred in 2 patients （ 10. 5% ） in group A, in group B early rebleeding occurred in 7 cases （ 18.4% ） and late rebleeding occurred in 12 patients （31.6%）. Conclusion Combined treatment of esophagogastric varices is more effective and safe than endoscopic tissue adhesive injection treatment alone.