联合内镜注射组织黏合剂与经皮肝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 combine of endoscopic injection of tissue adhesive and percutaneous transhepatic embolization

目的:评价内镜下注射组织黏合剂(histoacryl)与内镜下注射组织黏合剂联合经皮肝穿胃冠状静脉栓塞(PTVE)治疗胃底食管静脉曲张二种治疗方法的疗效。方法:对57例食管胃底静脉曲张患者分别进行内镜下注射组织黏合剂(单纯组38例)与内镜下注射组织黏合剂联合经皮肝穿胃冠状静脉栓塞(联合组19例),并比较两种方法止血率、再出血发生率、曲张静脉消失率、并发症发生率等指标。结果:二组随访2～24个月;近期再出血分别为5.3%、18.4%;>6个月再发出血发生率分别10.5%、31.6%;术后3～6个月行食道钡餐检查,食道静脉曲张消失或基本消失分别为68.4%、42.1%。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,是一种较安全、有效的方法。

Objective： To comparate 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 of 2 to 22 months was carried out in the two groups. Results： The follow-up endoscopy showed that the varices of esophaicgastric disappeared completely A group 68.4% and B group 42. 1% respectively, and re-bleeding 10.5% and 27% respectively ;It was observed that early re-bleeding A group 5.3% and B group 18.4%. Conclusion： Combined treatment group is more effective and safe alternative for EV therapy than only endoscopic tissue adhesive injection.