合并胃肾或脾肾分流道的胃静脉曲张内镜下联合注射治疗

Effect of combined sclerotherapy with N-butyl-2-cyanoacrylate and lauromacrogol in gastric varices patients with spontaneous gastro-renal shunt or spleno-renal shunt

目的探讨胃静脉曲张(GV)合并胃肾或脾肾分流道(SGRS或SSRS)患者经内镜下硬化剂联合组织黏合剂注射治疗的效果。方法选取解放军总医院2008年6月-2013年6月收治的经胃镜及CT检查证实为存在SGRS或SSRS的17例GV患者的临床资料进行回顾性研究,并对内镜下胃静脉曲张硬化剂联合组织黏合剂注射治疗效果进行初步分析。结果 17例患者均因间断呕血、黑便入院。乙肝肝硬化9例,乙肝合并原发性肝癌2例,酒精性肝硬化2例,隐源性肝硬化1例,门脉海绵样变1例,结肠癌术后门静脉系统血栓1例,Wilson氏病1例。胃静脉曲张分型GOV-1型2例,GOV-2型11例,IGV-1型4例,无IGV-2型。胃肾分流道13例,脾肾4例。17例患者均行内镜下硬化剂联合组织黏合剂注射治疗,术后无异位栓塞等并发症发生。结论合并SGRS或SSRS的GV,经内镜下硬化剂联合组织黏合剂注射治疗,在有效治疗GV同时也可最大限度地降低组织黏合剂固化物经分流道致异位栓塞发生的可能性。治疗前应行胃镜及门静脉CT血管成像检查,直观了解胃底静脉曲张情况及其交通支、分流道情况。

Objective To analyze the effect of combined endoscopic sclerotherapy with N-butyl-2-cyanoacrylate and lauromacrogol in patients suffered from gastric varices （GV） with spontaneous gastro-renal shunt （SGRS） or spleno-renal shunt （SSRS）.Methods The clinical data of 17 cases suffered from GV with SGRS or SSRS from Jun.2008 to Jun.2013 in the General Hospital of PLA were analyzed retrospectively.The effects and complications of sclerotherapy with N-butyl-2-cyanoacrylate and aethoxyskerol were analyzed.Results Seventeen cases were all admitted because of hematemesis and melena.There were 9 cases of HBV cirrhosis,2 cases of hepatocellular carcinoma,2 cases of alcoholic cirrhosis,1 cases of cryptogenic cirrhosis,1 case of portal cavernoma,1 case of portal vein thrombosis after colonic cancer operation and hepatolenticular degeneration.There were 2 cases of gastroesophageal varices type-1 （GOV-1）,1 cases of GOV-2,4 cases of IGV-1 and no IGV-2.Thirteen cases were SGRS and only 4 cases were SSRS.All cases were treated with combined endoscopic sclerotherapy with N-butyl-2-cyanoacrylate and lauromacrogol,no ectopic embolism occurred.Conclusion Combined endoscopic sclerotherapy with N-butyl-2-cyanoacrylate and lauromacrogol in GV patients with SGRS or SSRS have visible therapeutic effects as well as can reduce the ectopic embolism.Before endoscopic therapy,CT angiography is an essential method,which can observe the degree of GV and reveal the collateral circulation characteristics of portal system.