胃静脉曲张内镜下黏合剂栓塞治疗后排胶与再发出血的关联

Correlation between glue cast extrusion and re-bleeding after endoscopic gastric varices obturation using tissue adhesive

目的研究胃静脉曲张内镜下黏合剂栓塞治疗后排胶过程与再发出血之间的关联和影响。方法回顾性分析2010年1月至2017年7月期间,上海交通大学医学院附属瑞金医院消化科病房收治,经胃镜检查明确存在胃静脉曲张,并接受了内镜下黏合剂注射栓塞治疗术的患者,对其行内镜随访至少1年,分析其病史资料、内镜所见、治疗情况及随访结果。结果总计55例患者接受了内镜下胃静脉曲张黏合剂注射栓塞治疗术,其中男性33例,女性22例,平均年龄(60. 0±14. 6)岁,其中GOV1型12例(21. 8%),GOV2型11例(20. 0%),IGV1型32例(58. 2%)。共行黏合剂治疗58次,注射部位64点,平均每点注射1%聚桂醇(3. 79±1. 55) ml,组织黏合剂(3. 02±1. 17) ml。所有患者在1年的随访期间均生存,10例患者(7例IGV1型,3例GOV2型)再发上消化道出血共11次,其中排胶溃疡未愈8次、静脉曲张再发出血2次、胃角溃疡出血1次。排胶溃疡完全愈合的时间平均为(8. 3±3. 4)个月,其中36例患者(69. 2%)于术后4～9个月完成整个排胶过程。对排胶过程≥12个月的患者共9例随访至2年,所有患者均完成排胶,且随访期间未发生上消化道出血。结论内镜下黏合剂注射栓塞治疗术为胃静脉曲张破裂出血的重要二级预防手段。黏合剂注射术后排胶为正常现象,术后再发出血可能和曲张静脉栓塞不完全相关,确保曲张静脉完全栓塞或有助于降低术后再发出血风险。

Objective To investigate the correlation between glue cast extrusion and re-bleeding after endoscopic gastric varices obturation using tissue adhesive.Methods The inpatients of Department of Gastroenterology,Shanghai Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine during January2010and July2017were reviewed.All the patients received endoscopic gastric varices obturation using tissue adhesive and were followed-up by endoscopy for at least12months.The medical history,endoscopic features,treatment and follow-up results were studied.Results A total of55patients received endoscopic gastric varices obturation(33male,22female,average age(60.0±14.6)years old),with12cases of type GOV1(21.8%),11cases of GOV2(20.0%)and32cases of IGV1(58.2%).Fifty-eight endoscopic procedures were performed on64sites,with an average dose of(3.79±1.55)ml of1%polidocanol and(3.02±1.17)ml of tissue adhesive per injection site.All patients survived in the1-year follow-up period among which11re-bleeding sessions in10patients(IGV1in7patients and GOV2in3)were observed.The cause of re-bleeding included8cases of glue cast extrusion ulceration,2cases of new gastric varices and a case of angular ulcer of the stomach.The average period for healing of glue extrusion ulcer was(8.3±3.4)months,with the healing process completed within4-9months in36patients(69.2%).Follow-up was extended to2years in9patients with a glue cast extrusion process≥12months,during which extrusion was completed in all patients without re-bleeding.Conclusion Endoscopic gastric varices obturation using tissue adhesive is an important secondary prevention method for gastric varices bleeding.Glue cast extrusion is a normal phenomenon after endoscopic gastric varices obturation.Re-bleeding could be associated with inadequate obturation of the gastric varices.It could be helpful to ensure complete obturation of the gastric varices in order to reduce the risk of re-bleeding.