内镜下钛夹联合组织胶治疗GOV2型胃底静脉曲张30例

Endoscopic clipping with histoacryl in management of type 2 gastroesophageal varices(30 cases)

目的总结该院30例应用内镜下钛夹联合组织胶预防和治疗GOV2型胃底静脉曲张的临床经验,初探钛夹辅助治疗的临床应用价值。方法收集该院2015年5月-2016年12月GOV2型胃底静脉曲张患者病例资料(包括急性出血和一级预防)30例行病例分析,分析钛夹辅助治疗对术中组织胶注射、术中出血、术后静脉消除、再出血结局,以及排胶出血、异位栓塞发生的影响。结果术中平均组织胶用量(1.46±0.70)ml,平均钛夹用量5或6个,术中拔针出血2例(6.7%)。术后共14例患者(46.7%)行内镜下复查,静脉消除者3例(10.0%),残留者11例(36.7%);随访期内再出血4例(13.3%),死亡2例(6.7%),1例为术后呕血,失血性休克死亡;另1例术后发生自发性腹膜炎,感染性休克死亡。总体疗效看,治愈2例(6.7%),好转22例(73.3%),未愈6例(20.0%,包括再出血4例,死亡2例);术后17例患者行门静脉CT血管成像检查,无1例发生异位栓塞。术后排胶出血1例(3.3%),余患者无严重术后并发症发生。结论内镜下钛夹联合组织胶可应用于预防、治疗GOV2型胃底静脉曲张,或可提高治疗效果,降低术中(或)术后出血、异位栓塞风险,具有良好的临床应用价值,值得进一步临床研究。

Objective To summarize clinical experience and explore application value of endoscopic clipping with histoacryl using in management of type2gastroesophageal varices.Methods Clinical data of30patients with type2gastroesophageal varices patients(including acute hemorrhage and primary prevention)from May2015to December2016were collected.Then evaluate therapeutic effect and safety of endoscopic clipping adjuvant therapy.Results Average glue dosage was(1.46±0.70)ml,average using of clips were(5~6),and intraoperative needle pulling hemorrhage occurred in2cases.14patients(46.7%)underwent endoscopic re-examination,3patients(10.0%)achieved varicose vein elimination,11cases(36.7%)remained residual.Rebleeding occurred in4cases(13.3%),and2cases died(6.7%),one because of postoperative hematemesis and hemorrhagic shock,the other one died of spontaneous peritonitis and septic shock.For general curative effect,2cases(6.7%)were healed,22cases(73.3%)were improved,and6cases were unhealed(20.0%,4cases occurred rebleeding,2cases died);17cases underwent CT portal venograpy,abnormal embolization was not found in any patients,glue extrusion bleeding occurred in1case(3.3%),no patients had severe postoperative complications.Conclusion Endoscopic clipping with histoacryl can be used in the prevention and treatment of type2gastroesophageal varices to improve the treatment effect and reduce postoperative bleeding risk,may have good clinical practice value.