外科脾切除并断流或分流术后复发食管静脉曲张出血内镜下套扎及随访

Cirsodesis under Endoscope to Treat Recurrent Hemorrhage from Esophageal Varies after Surgical Splenectomy, Azygoportal and Shunt, as well as the Significance of Follow-up Survey

目的 :探讨外科脾切除并断流或分流术后复发食管静脉曲张出血内镜下套扎的价值及套扎后随访的意义 .方法 :在输血扩容同时内镜下明确出血部位立即套扎 ,14d后再套扎第二次 ,共行 2～ 4次套扎 .定期 (1～ 5a)随访 .按“食管胃底静脉曲张内镜下诊断和治疗规范试行方案”判断疗效 .结果 :32例患者共行 77次 72 5处曲张静脉套扎 ,总有效率 86 7% ,急诊止血率 94 4 % .全部病例无术后并发症发生 .存活的30例 ,经内镜套扎后随访 1～ 5a ,平均 2 83a ,结果复发率 2 6 7% ,复发出血率 6 7% .复发者再次镜下套扎 ,其中 2例复发出血 ,经急诊套扎出血停止 .结论 :内镜下套扎是外科脾切除并断流或分流术后复发食管静脉曲张出血的首选治疗方法 .在曲张静脉消失前重复套扎可降低术后复发率 .外科术后病人也应定期内镜随访 。

Objective: To investigate and discuss the value of cirsodesis under endoscope to treat recurrent hemorrhage from esophageal varies after surgical splenectomy, azygopcrtal and shunt, as well as the significance of follow-up survey after cirsodesis. Methods: Transfusing to cause volume preloading, meanwhile, locating the hemorrhage spots under the endoscope, then performing cirsodesis immediately, repeating for the second time 4 days later, altogether 2～4 times, finally to judge the curative effect according to the Diagnosis and Treatment Rule of varices of gastric fundus and esophagus. Results: After performing altogether 77 times, the utter effective rate for 725 cirsodesis in 32 cases was 86 7%, hemostasis rate of emergency was 94 4%, no postoperative complication was found in 30 cases survived and followed up 1～5 years after cirsodesis under the endoscope with an average of 2 83 years, the recurrent rate was 26 7%, the recurrent hemorrhage rate was 6 7%. The recurrent cases were given cirsodesis under endoscope again. Among which 2 cases hemorrhage recurred and the hemorrhage was stopped after emergent cirsodesis. Conclusion: Cirsodesis under endoscope should be the first on the therapy list to treat recurrence of hemorrhage from esophageal varices after surgical splenectomy, azygoportal and shunt, to repeat cirsodesis before varicose vein disappears can reduce postoperative recurrent rate and patients should follow up periodically after operation. Immediate cirsodesis is effective measure to reduce hemorrhage recurrence.