食管静脉曲张硬化治疗术后并发黏膜下血肿的临床治疗分析(附5例报道)

Clinical analysis of esophageal submucosal hematoma caused by endoscopic injection sclerotherapy: 5-cases-report and literature review

目的了解食管静脉曲张硬化剂治疗术(EIS)后形成食管血肿(EH)的诊断、内镜下治疗及预后分析,并对EIS后EH形成的病因及预防措施做进一步探讨。方法共有5例患者诊断EH纳入研究,其中4例EH患者接受内镜下胃肠管置入术并联合肠内营养治疗,1例单纯内科药物保守治疗。结果 5例患者恢复良好。相比较于单纯内科药物保守治疗的患者,接受内镜引导下胃肠管置入术的患者可缩短治疗疗程并明显改善患者一般状况。4例接受胃肠管置入术的患者均未发生明显治疗相关不良反应。结论内镜下胃肠管置入术尽早行肠内营养联合积极药物治疗对EIS后形成EH有效,规范术中操作及术后积极的处理措施有助于EH的预防。

Objective To study the etiology clinical features,treatment outcomes and prevention of esophageal submucosal hematoma caused by endoscopic injection sclerotherapy(EIS)of esophageal varices.Methods We retrospectively reviewed the clinical data of patients who were diagnosed with esophageal submucosal hematoma caused by EIS and treated in our hospital from Jan2014to July2016.Five patients were analyzed including one patient receiving endoscopic gastrointestinal catheterization combined with medication,and the remaining four received medication therapy only.Results All five patients were discharged with clinical improvement.However the patients treated only with medication therapy recovered more slowly than the ones who treated with combined therapy.No treatment related side-effects were observed among two treatment groups.Conclusion Endoscopic gastrointestinal catheterization combined with medication may be an effective treatment for esophageal submocasal hematoma caused by EIS.However,the actual clinical efficacy and safety remain to be proven by future large sample randomized clinical studies.