内镜下尼龙圈辅助组织胶注射治疗胃静脉曲张伴胃肾分流的临床研究

Clinical study of nylon loop-assisted endoscopic cyanoacrylate injection in the treatment of gastric varices with gastrorenal shunt

目的探讨创新性应用内镜下尼龙圈辅助组织胶注射治疗胃静脉曲张伴胃肾分流的安全性和疗效。方法回顾性分析首都医科大学附属北京地坛医院2017年6月至2020年6月行内镜下尼龙圈辅助组织胶注射治疗的8例胃静脉曲张伴胃肾分流患者的临床资料,分析内镜下治疗前及内镜下治疗后10 d肝功能、肾功能、血细胞的变化,观察内镜下即时止血率及内镜下治疗后3 d、1周、6周早期再出血率,内镜下治疗后10 d、6个月随访并发症发生情况及静脉曲张治疗情况。结果内镜下治疗后丙氨酸氨基转移酶、门冬氨酸氨基转移酶较治疗前下降,差异有统计学意义[(14.33±6.06)U/L vs(20.66±8.73)U/L,(25.61±8.68)U/L vs(36.46±18.10)U/L,P<0.05];内镜下治疗后总胆红素、白蛋白、血肌酐、白细胞、血红蛋白、血小板较治疗前无明显改变,差异无统计学意义(P>0.05)。所有患者均成功止血,内镜下治疗后3 d、1周、6周均未再发消化道出血。内镜下治疗后有2例患者分别出现一过性发热、上腹部不适,对症治疗后好转,内镜下治疗后10 d及6个月随访所有患者均无体循环异位栓塞发生;内镜下治疗后6个月随访复查显示6例患者静脉曲张基本消失,2例患者静脉曲张改善。结论内镜下尼龙圈辅助组织胶注射治疗胃静脉曲张伴胃肾分流对肝功能有一定的改善,可有效治疗胃静脉曲张伴胃肾分流,同时也可避免内镜下治疗后体循环异位栓塞发生,有良好的安全性和疗效。

Objective To investigate the safety and efficacy of endoscopic nylon loop-assisted cyanoacrylate injection in the treatment of gastric varices with gastrorenal shunt.Methods A retrospective analysis was performed for the clinical datas of 8 cases of gastric varices with gastrorenal shunt treated by nylon loop-assisted endoscopic cyanoacrylate injection in our hospital from June 2017 to June 2020.The changes of liver function,renal function and blood routine were analyzed before endoscopic treatment and 10 days after endoscopic treatment.The immediate hemostatic rate and early rebleeding rate of 3 days,1week and 6weeks after operation were observed,the postoperative complications and the efficacy of endoscopic treatment were observed 10 days and 6 month after operation.Results ALT and AST after endoscopic treatment were significantly lower than those before treatment[(14.33±6.06)U/L vs(20.66±8.73)U/L,(25.61±8.68)U/L vs(36.46±18.10)U/L,P<0.05].There were no significant changes in TBil,Alb,Cr,WBC,Hb and PLT after endoscopic treatment.All the patients achieved successful hemostasis,and there was no rebleeding in 3 days,1 week and 6 weeks after endoscopic treatment.After operation,2 patients developed transient fever or epigastric discomfort respectively,which improved after symptomatic treatment.There was no systemic embolization in all patients 10 days and 6 month after operation.6 months after operation varices were basically disappeared in 6 patients,and improved in 2 patients.Conclusion Nylon loop-assisted endoscopic cyanoacrylate injection is safe and effective in the treatment of gastric varices with gastrorenal shunt.