内镜下金属钛夹联合组织胶注射治疗胃底静脉曲张22例

Preliminary study of endoscopic metal titanium clip combined with tissue gel injection for treatment of gastric varices:a report of 22 cases

目的探讨内镜下金属钛夹联合组织胶注射治疗食管静脉曲张沿胃底方向延续的曲张静脉(GOV2型)和位于胃底的孤立胃曲张静脉(IGV1型)的临床疗效。方法回顾性分析2016年9月至2018年10月安徽医科大学第一附属医院22例GOV2型及IGV1型胃底静脉曲张并行内镜下金属钛夹联合组织胶治疗病人的临床资料(包括急性出血、预防首次出血及预防再出血)。观察统计术中组织胶注射剂量、胃底曲张静脉注射点数,术后再出血率(包括近期再出血率和迟发性再出血率)、内镜下胃底曲张静脉消退情况及并发症发生情况。结果22例胃底静脉曲张病人中,GOV2型7例,IGV1型15例,男14例,女8例,年龄(59.23±12.42)岁。术中组织胶注射剂量(3.84±1.52)mL、胃底曲张静脉注射点数(2.82±0.98)个。术后总再出血率为9.1%(2/22),其中近期再出血率为4.5%(1/22)、迟发性再出血率为4.5%(1/22);术后1个月,内镜下胃底曲张静脉消失显效者占68.2%(15/22)、有效者占22.7%(5/22)、无效者占9.1%(2/22);术后所有病人均未发现异位栓塞、消化道穿孔、自发性腹膜炎、菌血症等严重并发症,并发症总发生率为22.7%(5/22)。结论内镜下金属钛夹联合组织胶注射治疗胃底静脉曲张,可能提高疗效、减少术后再出血、降低异位栓塞风险,但仍需进一步研究。

Objective To investigate the clinical efficacy of endoscopic metal titanium clip combined with tissue gel injection in the treatment of GOV2 and IGV1 gastric fundus varices.Methods Retrospective analysis of clinical data of 22 patients with GOV2 and IGV1 gastric fundus varices and endoscopic metal titanium clip combined with tissue glue in The First Affiliated Hospi tal of Anhui Medical University from September 2016 to October 2018(including acute bleeding,prevention of first bleeding and prevention Bleeding again).Observe the average injection dose of tissue glue,the average number of injection points of gastric vari ces,the rate of rebleeding after endoscopic surgery(including recent rebleeding and delayed rebleeding),the regression of endoscopic varices and complications.Results Of the 22 patients with gastric varices,7 were GOV2,15 were IGV1,14 were male and 8 were female.The average age of patients was(59.23±12.42)years old.The average injection dose of intraoperative tissue glue was(3.84±1.52)mL,and the average number of injection points of gastric varices were(2.82±0.98).The total rebleeding rate after sur gery was 9.1%(2/22),of which the recent rebleeding rate was 4.5%(1/22),and the delayed rebleeding rate was 4.5%(1/22).One month after surgery,endoscopic gastric varices disappeared significantly 68.2%(15/22),effectively 22.7%(5/22),and ineffective 9.1%(2/22);no ectopic embolism was found in all patients after surgery.Serious complications such as perforation of the digestive tract,spontaneous peritonitis,and bacteremia,the total incidence of complications was 22.7%(5/22).Conclusion Endoscopic met al titanium clip combined with tissue gel injection for treatment of gastric varices may improve the efficacy,reduce postoperative rebleeding,and reduce the risk of ectopic embolization,but further research is needed.