经内镜注射组织粘合剂治疗食管胃静脉曲张

Endoscopic injection of tissue glue to treat esophagogastric varices

目的为评价内镜下注射组织粘合剂（ｃｙａｎｏａｃｒｙｌａｔｅ）治疗食管胃静脉曲张疗效。方法对３９例食管胃静脉曲张出血注射组织粘合剂患者进行分析。孤立性胃静脉曲张１１例，食管、胃静脉曲张硬化治疗后残留胃静脉曲张２１例，断流术后胃静脉曲张出血１例，食管胃静脉曲张以胃静脉曲张为主６例。ｌｉｐｉｏｄｏｌ和ｃｙａｎｏａｃｒｙｌａｔｅ的配比为１∶１，每点注射混合液０．５～１ｍｌ。结果急诊注射１６例，止血１５例，占９３．７％。择期治疗２３例，３～６个月组织粘合疗剂完全排出，静脉曲张消失。近期排胶再发出血５例，占１２．８％。随访２～１６月，平均７．８月，复发出血３例，占７．７％。结论组织粘合剂注射治疗胃静脉曲张是一较安全、有效的方法。

Objective The efficacy of endoscopic injection of cyanoacrylate as the sole treatment for esophagogastric varices(EV)was assessed.Methods 39 patients with EV subjected to the injection,of which 11 had isolate gastric varices (GV), 21 had postoperative residual GV, 6 had dominant GV. 0.5～2.0ml of 1:1 mixture of cyanoacrylate and lipiodol was injected into each point. Results The majority of injections in this series were executed in selective cases, except 16 with acute bleeding who received emergent injections with 15 checked (93.7%). It was observed that at follow ups(3～6 months) the injected glue was rejected from EV, resulting in eradication. Early rebleeding after injection in 5 cases (12.8%) was estimated from undue rejection of the adhesive.Late rebleeding occurred in 3 patients(7.7%) at 2～16 months (mean 7.8 months). Lipiodol was seen flowing into lung vessels during injection in 4 with no serious cough nor signs of ectopic embolism. Conclusion Tissue adhesive injection is an effective and safe alternative for EV therapy.