肝硬化合并贲门区曲张静脉破裂出血134例内镜诊疗分析

Endoscopic diagnosis and therapy for 134 cirrhotic patients with cardiac variceal bleeding

目的回顾性分析急诊内镜治疗肝硬化合并贲门区曲张静脉破裂出血的疗效。方法以内镜下硬化术、套扎术和组织粘合剂栓塞术等手段治疗134例肝硬化合并贲门区曲张静脉破裂出血。结果 134例中,121例(90.3%)止血成功,内镜下硬化术和组织粘合剂栓塞术的止血率分别为89.8%和95.8%。死亡4例,72 h内病死率为4.5%,原因为失血性休克、肝性脑病和多脏器功能衰竭。胃镜操作过程中未见死亡病例。结论肝硬化合并贲门区曲张静脉破裂出血,以内镜下硬化术和栓塞术治疗可获得较好的近期效果。

Objective To retrospectively analyze the effect of endoscopic therapy on acute cardiac variceal bleeding in pa-tients with liver cirrhosis. Methods Endoscopic injection sclerotherapy, endoscopic variceal ligation and embolization were used in the management of acute cardiac variceal bleeding in 134 cirrhotic patients. Results Variceal bleeding was controlled in 121 patients （ 90 . 3%） , by endoscopic injection sclerotherapy in 97 patients （ 89 . 8%） and embolization in 23 patients （ 95 . 8%） . Four patients died from hemorrhagic shock, hepatic encephalopathy and multiple organ failure, and the 72-hour mortality was 4.5%. No patient died during endoscopic procedure. Conclusion Endoscopic injection sclerotherapy and embolization can achieve good short-term effects in the management of cardiac variceal bleeding in cirrhotic patients.