内镜套扎联合注射组织黏合剂治疗食管胃底静脉曲张

Varices of Fundus of Stomach and Esophagus Treated by the Endoscopic Variceal Ligation Combining with the Injection of Histoacryl

目的总结内镜下套扎并联合注射黏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92例,及经过套扎术后诱发加重的16例胃底静脉曲张破裂出血者联合内镜下组织黏合剂注射治疗的临床资料进行回顾性分析。结果92例套扎治疗者,平均每套扎2.3次,共进行174例次772处套扎,显效64例（69.5%）,有效24例（26.2%）,其中4例并发大出血失败（4.3%）,总有效率（95.7%）,16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%）,经联合注射组织黏合剂治疗后静脉曲张消失,5个月后胃镜复查组织黏合剂完全排出,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著,对套扎术后诱发加重胃底静脉曲张破裂出血,联合镜下组织黏合剂注射获得满意疗效。

Objective Result into the clinical efficacy of the mp tured 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 enneeming 92 cases of RHVFSE patients treated by the continuous EVL and 16 cases of patients who had raptured hemorrhage of varices of fundus of stomach and was more serious after the EVL. Remit For 92 EVL cases, it was 2.3 times each case and 772 ligations for 174 case / times, 64 cases produced effect （69.5%）, 24 cases were effective （26.2%） and 4 cases were failed due to the complication of massive hemorrhage with the effective rate being 95.7%.Among them, there were 16 cases had IV~ V Grade vafices of fundus of stomach after 4-12 weeks of EVL with the incidence being 17.4%.The varices of fundus of stomach disappeared after injecting the histoacryl and the histoacryl was drained out after 5 months without hemorrhage any more. Conclusion The efficacy of mptured hemorrhage of esophagus variees 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.