内镜下组织粘合剂注射和套扎术治疗儿童食管胃静脉曲张出血24例临床观察

Comparison of histoacryl injection and endoscopic variceal ligation for the treatment of gastroesophageal varices in 24 children

目的评价内镜下组织粘合剂注射和套扎术(EVL)治疗儿童食管胃静脉曲张(GOV)的临床疗效。方法分析2009年10月至2013年11月在复旦大学附属儿科医院因GOV出血接受内镜下治疗的24例患儿的临床资料,总结治疗后即时止血率、再出血率及并发症情况。结果 24例患儿平均年龄(8.0±3.2)岁,男15例,女9例,其中1型GOV(GOV1)6例、2型GOV(GOV2)18例,平均随访10.5(1～32)个月。共行内镜下EVL治疗24例,平均每例套扎4(2～7)环;组织粘合剂注射治疗19例,平均每例组织粘合剂注射量为1(0.5～1.5)mL。即时止血率为100%,3个月内再出血率16.7%(4/24),3个月以上再出血率16.7%(4/24),其中2例于治疗后3个月内死亡,6例(25%)于随访期间因出血复发而再次行内镜下治疗,平均套扎2.8(2～5)次。术后均未见明显并发症。结论内镜下组织粘合剂注射和EVL治疗GOV疗效确切,并发症少,是治疗儿童GOV的有效措施。

Objective To evaluate the clinical efficacy of histoacryl injection and endoscopic variceal ligation( EVL) in the management of children with gastroesophageal varices( GOV). Methods Data of 24 consecutive patients with GOV between October 2009 and November 2013 were collected. EVL was used for esophageal varices and histoacryl injection for gastric varices. Instant hemostatic rate,rebleeding rate and complications were evaluated. Results The mean age of 24 patients was 8 years( 15 males,9 females). According to Sarin classification,6 were GOV1 and 18 were GOV2. Mean follow-up duration was 10. 5( 1- 32) months. 24 patients underwent EVL and the mean number of loops was 4( 2- 7) loops. And 19 patients with gastric varices underwent endoscopic histoacryl injection,the average volume of 1 mL histoacryl was used. The instant hemostatic rate was 100%. The rate of early rebleeding within 3 months was 16. 7%,and the rate of rebleeding after 3 months was 16. 7%. Two cases were died within 3 months after treatment. And in 6 cases,endoscopic treatment was used again and the average number of sessions was 2. 8( 2- 5). No severe complications were observed. Conclusion Histoacryl injection and EVL are effective and safe procedure for the treatment of GOV in children.