α-氰丙烯酸烷基酯栓塞治疗胃静脉曲张破裂出血的临床观察

Clinical observation of embolotherapy by endoscopic injection with α-cyanoacrylate alkyl for treatment of gastric varices bleeding

目的评价经内镜注射组织黏合剂α-氰丙烯酸烷基酯栓塞治疗胃静脉曲张的临床疗效及不良反应。方法 18例临床确诊的肝硬化合并急性胃静脉曲张破裂出血的患者中,活动出血5例,近期出血13例,胃静脉曲张Sarin分类胃食管静脉曲张Ⅰ型(GOV1)7例,胃食管静脉曲张Ⅱ型(GOV2)8例,孤立性胃静脉曲张Ⅰ型(IGV1)7例,在静脉滴注奥曲肽的同时,经内镜首先选择靶静脉及穿刺点,根据曲张静脉的直径确定组织黏合剂的剂量,依次对胃曲张静脉采用三明治法进行组织黏合剂栓塞治疗,11例合并食管静脉曲张的患者在栓塞治疗后联合食管曲张静脉套扎治疗,术后进行内镜随访,观察止血成功率、早期再出血率、病死率、静脉曲张消退情况以及不良反应。结果急诊止血成功率100%,早期再出血率0%、静脉曲张消退显效13例(72.2%),有效3例(16.7%),无效2例(11.1%);3例出现术后低热,1例出现大肠杆菌败血症;11例注射部位出现糜烂,4例注射部位形成溃疡;1例术中出血。结论经内镜注射组织黏合剂α-氰丙烯酸烷基酯栓塞治疗胃静脉曲张破裂出血是一种简便、安全、有效的方法。

Objective To evaluate the clinical effect and side effect of the tissue adhesive named α-cyanoacrylate alkyl in the treatment of gastric variceal.Methods 18 patients with gastric variceal bleeding who were diagnosed by endoscopy received tissue adhesive,among which 5 cases were active bleeding and 13 cases were recent bleeding.Based on Sarin Classification of Gastric Varices,7 cases belonged to type Ⅰ of gastroesophageal varices（GOV_1）,8 cases to type Ⅱ of gastroesophageal varices（GOV_2） and 7 cases to type Ⅰ of isolated gastric varices（IGV_1）.During the process of octreotide being given venously,gastric varices to be treated and injection spot were chosen by means of endoscopy.The dose of tissue adhesive was determined according to the diameter of varices.To cure the gastric varices,sandwich method was adopted by means of tissue adhesives.11 patients with both gastric and esophageal varices were first treated by injection of the tissue adhesive and then the esophageal varices were ligated.After the operation,the patients received follow-up endoscopy,their rates in controlling bleeding,eradication of gastric varices,the mortality and the side effect were observed.Results The rate in controlling bleeding was 100%,the rate of early re-bleeding was 0%;the varices in 13 patients were eradicated significantly（72.2%）,3 patients were effective（16.7%）,2 patients were ineffective（11.1%）;3 patients had low fever,septecemia occurred in 1 patient,2 patients revealed asymptomatic post-injection ulcers and erosion occurred in 11 patients at injection site from tissue adhesive after endoscopic treatment.Conclusion The method of injection of tissue adhesive under endoscopic guidance for treatment of gastric varices was convenient,safe and effective.