内镜超声引导弹簧圈栓塞治疗胃静脉曲张的初步评价(含视频)

The therapeutic effects of endoscopic ultrasound-guided coil embolization for gastric varices(with video)

目的探讨内镜超声引导弹簧圈栓塞治疗胃静脉曲张的疗效及安全性。方法纳入2016年11月-2020年8月在复旦大学附属中山医院接受择期内镜超声引导弹簧圈栓塞治疗胃静脉曲张的门静脉高压患者。主要评价指标为术后曲张静脉团内血流消失情况,次要指标包括弹簧圈栓塞的安全性、再出血率、门静脉血栓变化和患者生存情况。结果共13例合并门体分流的孤立胃静脉曲张患者纳入研究,其中男6例、女7例,中位年龄58岁。内镜超声检查提示靶血管中位最大内径为40mm,置入弹簧圈中位数量为2.7个。穿刺点均位于食管下端接近贲门口处,均无活动性出血,患者操作完成后均经多普勒辅助确认血流完全消失。中位随访时间403d,2例患者发生再出血,术后1年再出血率为9.1%;2例患者术后出现门静脉系统血栓进展;2例患者死亡,术后1年生存率为90.0%。结论内镜超声引导弹簧圈栓塞是存在门体分流的孤立胃静脉曲张患者的有效治疗方法。

Objective To investigate the safety and efficacy of endoscopic ultrasound-guided coil embolization for gastric varices.Methods Patients with portal hypertension who received endoscopic ultrasound-guided coil embolization for the prophylaxis of gastric variceal bleeding between November 2016 and August 2020 at Zhongshan Hospital,Fudan University were included in the study.The primary evaluation index was the post-operative loss of blood flow in gastric varices,and the secondary indices included the safety of coil embolization,rebleeding rate,portal vein thrombosis changes and patient survival.Results A total of 13 patients with isolated gastric varices and portal systemic shunt were enrolled,including 6 males and 7 females with the median age of 58 years.The median maximum diameter of the target vessel was 40 mm and the median number of coils used was 2.7.All puncture sites were in the lower parjt of the esophagus near the cardia,and no active bleeding occurred after deployment of coils.Flow in the gastric varices were confirmed absent by Doppler imaging.In a median follow-up period of 403 days,2 patients had rebleeding,with the one-year rebleeding rate of 9.1%.Two patients developed portal venous thrombosis after the operation.Two patients died,and the one-year survival rate was 90.0%.Conclusion Endoscopic ultrasound-guided coil embolization might be an effective option for the treatment of isolated gastric varices with portal systemic shunts.