内镜治疗吻合口静脉曲张诊治体会

Endoscopic on diagnosis and treatment of anastomotic varices

目的评估内镜治疗吻合口静脉曲张(AV)的疗效和安全性,并探讨最佳治疗策略。方法回顾性分析2006年1月至2020年12月经解放军总医院第一医学中心消化内科医学部内镜检查明确诊断为AV患者共8例,分析其临床特征、内镜表现、治疗方法、不良事件和随访结果等临床特点。结果8例患者中,4例患者伴门脉海绵样变、1例肝硬化,呕血、黑便为最主要首发症状。内镜检查中,2例见活动性出血、3例静脉曲张红色征阳性;5例患者接受了内镜下治疗中,3例行内镜下组织胶注射治疗、1例硬化剂治疗、1例曲张静脉套扎术。内镜总体即刻止血成功率100%,5 d治疗失败率为20%、6周内死亡率为0、不良事件仅1例出现发热。在随访期间,因再次出血保守治疗止血失败死亡1例。结论AV少见,出血量大、诊断困难、无标准治疗方法。内镜下治疗消化道AV破裂出血安全、可靠、易行。该病复发出血率较高,应强调内镜随访,必要时需重复内镜下治疗或行介入等其他治疗。

Objective To evaluate the efficacy and safety of endoscopic treatment for patients with anastomotic varices(AV)and explore the optimal treatment.Methods Eight patients with AV were enrolled.These patients were diagnosed by endoscopy from 2006 to 2020 in our center.Clinical features,endoscopic findings,treatment methods,adverse events and follow-up data were analyzed retrospectively.Results Of the 8 patients,4 had cavernous transformation in portal vein,and 1with liver cirrhosis.Hematemesis and melena were the most common initial symptom.During endoscopic examination,active bleeding in 2 cases and positive red color signs in other 3 cases were found.Five patients received endoscopic treatment.Three cases were treated with endoscopic cyanoacrolate injection(ECI),one with endoscopic injection sclerotherapy(EIS),and one with endoscopic variceal ligation(EVL).Immediate hemostasis rate was 100%post-endoscopic treatment for anastomotic variceal bleeding.Five-day treatment failure ratio was 20%.Six-week mortality after endoscopic treatment for anastomotic variceal bleeding was 0.The only adverse event was fever in one patient.During the follow-up period,one rebleeding case died of failure of conservative treatment for rebleeding.Conclusions AV bleeding is rare and has the characteristics of difficult diagnosis,large volume of bleeding,difficult hemostasis,and poor prognosis.Endoscopic treatment of AV bleeding is feasible,safe,and effective.The recurrent bleeding rate of this disease is not satisfied,endoscope follow-up should be emphasized.If rebleeding occurring,endoscopic treatment or interventional treatment should still be used.