内镜下组织胶注射治疗急性食管胃静脉曲张出血疗效观察

Endoscopic N butyl-2-cyanoacrylate injection in the treatment of acute esophageal and gastric varices bleeding

目的 通过病例总结,探讨内镜下组织胶注射治疗急性食管胃静脉曲张出血的疗效。方法选取2018年6月至2021年6月江苏省南通市第三人民医院行急诊胃镜下治疗急性食管胃静脉曲张出血患者46例,其中男30例,女16例,平均年龄(54.6±10.6)岁,肝功能Child-Pugh分级,A级7例,B级22例,C级17例。无论食管胃底静脉曲张可以发现出血点的均采用组织胶注射;如胃底孤立性静脉曲张破裂出血,可根据情况必要时采用金属夹限流后再行组织胶注射;若无法明确出血部位的采用组织胶注射胃曲张静脉,聚桂醇注射食管静脉。结果出血部位位于胃底静脉曲张13例,贲门口16例,食管14例,未能明确出血点3例。急诊内镜下组织胶治疗后止血成功率达到97.8%,所有止血成功患者均在24 h内未有再出血的情况,2例患者出现6个月内的再出血,2例均为排胶溃疡伴出血,有2例患者出现门静脉血栓加重,无异位栓塞等其他严重并发症发生。结论内镜下组织胶治疗治疗急性食管胃静脉曲张出血疗效确切,并发症少,能够挽救患者的生命。

Objective To explore the efficacy of endoscopic N butyl-2-cyanoacrylate injection in the treatment of acute esophagogastric variceal hemorrhage through case summary.Methods A total of 46 cases of acute esophagogastric variceal hemorrhage were treated by emergency gastroscopy from June 2018 to June 2021,including 30 males and 16 females,with average age of 54.6 years old.Liver function grading:Child-Pugh grading was used,which was divided into ABC grade,including 7 cases of grade A,22 cases of grade B,and 17 cases of grade C.N butyl-2-cyanoacrylate injection should be used in all cases where bleeding points can be found in esophageal and gastric varices.If isolated varices in gastric fundus rupture and hemorrhage,metal clip can be used to limit the flow according to the situation and then tissue glue injection can be performed.If the bleeding site cannot be determined,N butyl-2-cyanoacrylate should be injected into gastric varices and cinnamyl alcohol should be injected into esophageal veins.Results Bleeding in 13 cases of gastric varices,Ben at the gate of 16 cases,14 cases of esophagus,failed to clear bleeder(3 cases),emergency endoscopic tissue glue hemostasis after treatment success rate reached 97.8%,all the bleeding patients were successfully within 24 hours with no bleeding again,two patients had six months to bleeding,two cases are gum ulcers with bleeding,There were two patients with portal vein thrombosis aggravation,embolism and other serious complications.Conclusion Endoscopic N butyl-2-cyanoacrylate injection for acute esophagogastric variceal hemorrhage is effective,less complications,and can save patients'lives.