内镜下一次性阻断贲门胃内曲张静脉对食管曲张静脉内血流阻断的疗效观察

The curative effect of endoscopic one-time blocking gastric varices on blood flow in the esophagus varicose vein occlusion

目的:探讨在内镜下一次性阻断贲门胃内曲张静脉对食管曲张静脉内血流阻断的临床治疗效果。方法:本研究以内镜下精准贲门胃静脉曲张断流术(ESVD)为主要治疗手段,选取72例肝硬化并发食管胃静脉曲张患者作为研究对象,确定曲张静脉后,向血管内注射聚桂醇、组织胶、空气和生理盐水溶液(STAN)。将患者随机分为两组,低剂量组给予2 ml聚桂醇,高剂量组给予3 ml聚桂醇。在7~14 d后对两组患者进行复查,用穿刺针对再次对食管静脉进行多点穿刺,如患者的食管曲张静脉内血流未被阻断,再于胃底以及贲门确定来源血管后再次给予同前治疗方法。如患者食管静脉血流发生堵塞后血管出现显著减轻乃至消失,嘱患者在3个月后再次来院复查。结果:低剂量患者在安全性上优于高剂量组。低剂量组患者一次性治疗后血管消失率为30.56%,高剂量组患者为38.89%;低剂量组患者穿刺印证血流阻断率为77.78%,高剂量组患者为80.56%;两组患者3个月内再次出血率未见显著性差异(P>0.05),均无死亡病例。结论:采用ESVD一次性治疗食管-胃连通型静脉曲张是一种较为安全的治疗手段,患者的静脉曲张一次性消除比例约为30%。

Objective To investigate the curative effect of endoscopic treatment of esophageal varicose veins in esophageal varicose veins. Method This study of endoscopic precise cardiac gastric varices cut-out operation（ ESVD） as main treatment means,72 patients with liver cirrhosis complicated with esophageal gastric varices were as the research object,after determining the varicose vein,intravascular injection of polycinnamic alcohol,tissue glue,air and saline（ STAN） solution. The patients were randomly divided into two groups. Group A gave 2 ml of polycinnamic alcohol,and group B gave 3 ml of polycinnamic alcohol. In7 to 14 d after on two groups of patients in the process of reviewing again with puncture for esophageal vein for multipoint puncture,such as in patients with esophageal varicose vein blood flow was not blocked,then on the bottom of the stomach and again given after cardia to determine the source of blood vessels with before treatment. If the patient＇s esophageal vein was blocked,the blood vessel appears to be significantly reduced or even disappeared,and the patient was told to come to the hospital for review after 3 months. Results Patients with low dose on security was better than that of high dose group. Low dose group was more safe than high dose group. After treatment,the vascular disappearance rate was 30. 56% in low dose group and 38. 89% in high dose group. Patients in low dose group confirmed that the blood flow blocking rate was 77. 78%,and high dose group patients were 80. 56%. There was no significant difference between the two groups of patients in 3 months（ P〉0. 05）. No deaths were reported. Conclusion The use of ESVD to treat esophageal and gastric connected varicose veins（ GOV1 and GOV2） is a relatively safe treatment,and the patient＇s varicose vein elimination rate is about 30%.