内镜治疗原发性肝癌食管胃底静脉曲张破裂大出血

Hemostasis with endoscopy for critical esophageal variceal bleeding in patients of hepatic carcinoma

目的总结原发性肝癌食管胃底静脉曲张破裂大出血药物控制无效时,行急诊内镜下治疗的救治经验。方法47例活动性大出血,急诊内镜下直接行硬化治疗27例、组织胶粘堵治疗2例;在二腔一囊管牵引压迫下行硬化治疗12例、硬化加组织胶粘堵治疗6例。结果39例成功止血,5例术后仍有出血,3例无效死亡,急诊止血率83.0%(39/47)。其中,8例在3个月内再次出血,近期再出血率18.2%(8/44)。结论选择合适的内镜治疗,可快速、有效地控制原发性肝癌并食管胃底静脉曲张破裂活动性大出血,延长生存期,并为进一步治疗赢得时间和创造条件。

Objective To summarize the outcomes of emergent endoscopic hemostasis for critical active esophageal variceal bleeding failled to be controlled by drug therapy in the patients with hepatocellular carcinoma. Methods Fourty-seven patients with critical active esophageal variceal bleeding, of whom emergent endoscopic hemostasis was performed in 27 cases, tissue adhesive injection in 2 cases, emergent sclerotherapy plus modified Senstaken-Blakmore tube compression in 12 cases, and sclerotherapy and tissue adhesive injection in 6 cases. Results Endoscope hemostasis was successful in 39 cases with an immediate effective hemostasis rate of 83.0%（39/47）, of whom 8 cases experienced rebieeding in 3 months with a short-term rehaemorrhage rate of 18.2%（8/44）. Endoscope hemostasis was failed in 5 cases and 3 cases died. Conclusion Endoscope hemostasis could effectively control emergent esophageal varieeal bleeding and save the time for taking advanced measures in the patients with hepatocellular carcinoma.