钛夹辅助下内镜组织胶注射治疗胃静脉曲张

Value of clip-assisted endoscopic cyanoacrylate injection for gastric varices

目的初步探讨钛夹辅助内镜下组织胶注射治疗胃静脉曲张的安全性、有效性及操作注意事项。方法回顾性分析2018年1月至2019年7月山东省立医院东院消化科行钛夹辅助下内镜组织胶注射治疗胃静脉曲张患者10例,经胃镜证实为GOV2型或IGV1型胃静脉曲张,术前强化CT及CTA显示均存在明显胃肾分流道。先在胃镜下观察胃曲张静脉团的供血或回流血管分支、并行钛夹夹闭,以减缓或阻断胃曲张静脉内血液流速,后再胃镜下行组织胶注射,以预防组织胶的异位栓塞。分析10例患者的操作成功率、静脉曲张消失、术后再出血率、并发症等情况。结果纳入的10例患者均成功进行钛夹辅助下内镜组织胶注射治疗,随访时间39~157 d,平均随访85.7 d。术后强化CT复查显示10例患者胃静脉曲张均基本消失或明显减轻。术后有1例患者发生排胶溃疡再出血,未出现异位栓塞相关的症状和体征,未出现其他明显并发症。结论钛夹辅助下内镜组织胶注射操作简便、安全,是合并胃肾分流的胃静脉曲张治疗的有效方式,值得进一步临床研究。

Objective To investigate the safety,efficacy and operation cautions of clip-assisted endoscopic cyanoacrylate injection for patients with gastric varices.Methods A retrospective study was performed on the data of 10 patients with gastric varices undergoing clip-assisted endoscopic cyanoacrylate injection in Department of Gastroenterology of Eastern District of Shandong Provincial Hospital Affiliated to Shandong University from January 2018 to July 2019.GOV2/IGV1 was confirmed by endoscopy examination and a gastro-renal shunt was confirmed by contrast-enhanced CT and CT angiography(CTA)for all patients.The inflow or outflow veins of the gastric varices were observed and clamped with metal clips to slow down or completely block the gastric variceal blood flow,followed by cyanoacrylate injection into the gastric varices,which could reduce the risk of ectopic embolization.The technical successful rate,the eradication of gastric varices,the rebleeding rate and complications were analyzed.Results All patients successfully completed the procedure.The mean follow-up was 85.7 days(range 39-157 days).Gastric varices were eradicated in all patients according to contrast-enhanced CT reexamination.Rebleeding occurred in one patient because of post-injection ulcer.No symptoms related to ectopic embolization occurred.No serious complications occurred.Conclusion Clip-assisted endoscopic cyanoacrylate injection is safe and reliable for gastric varices patients with gastro-renal shunt,which deserves further clinical research.