Successful endoscopic sclerotherapy for bleeding gastric varices with combined cyanoacrylate and aethoxysklerol

Two patients with liver cirrhosis and portal hyper-tension related to hepatitis infection were admitted to Shanghai Ruijin Hospital due to recurrent melena and hematemesis. Isolated gastric varices were observed in the gastric fundus during the retroflexion of gastroscope. We carried out endoscopic sclerotherapy successfully for bleeding gastric varices with combined cyanoacrylate and aethoxysklerol, which disappeared dramatically several months after two courses of sclerotherapy for each patient. No complication and clinical signs of gastrointestinal re-bleeding were observed during the 6-mo endoscopic follow-up. CT portal angiography (CTPA) has been widely used in the assessment of variceal treatment and improves the results of endoscopic injection therapy.

乙氧硬化醇和聚桂醇治疗食管静脉曲张破裂出血疗效及并发症比较

目的:对比观察内镜下注射硬化剂乙氧硬化醇与聚桂醇治疗食管静脉曲张破裂出血的疗效及并发症。方法:收集肝硬化合并食管静脉曲张破裂出血的患者227例均采用内镜下食管曲张静脉硬化剂注射治疗。根据硬化剂种类不同分成两组:A组120例次给予乙氧硬化醇注射治疗,B组107例次给予聚桂醇注射治疗。观察两组患者治疗后72h止血率及并发症如发热等的发生率。结果:两种硬化剂治疗后72h止血率相当,无明显差异,但是B组术后发热的发生率较A组升高,且有统计学意义,其余并发症的发生率两组无显著性差异。结论:内镜下采用乙氧硬化醇和聚桂醇治疗食管静脉曲张破裂出血,止血率相当,除发热外其它并发症发生率也无明显差异,聚桂醇是一种安全有效的硬化剂。

粘合剂联合硬化剂治疗瘤状孤立性1型胃静脉曲张

目的评价粘合剂α-氰基丙烯酸烷基酯联合硬化剂乙氧硬化醇治疗瘤状孤立性1型胃静脉曲张(IGV1)出血的临床疗效。方法对16例瘤状IGV1出血患者进行内镜下α-氰基丙烯酸烷基酯联用乙氧硬化醇注射治疗,观察临床止血疗效、胃静脉曲张消除情况及临床不良反应。结果全组16例患者粘合剂和硬化剂平均注射次数为(1.56±0.51)次,α-氰基丙烯酸烷基酯每例平均注射(1.36±0.20)ml,乙氧硬化醇每例平均注射(7.13±2.96)ml,即时止血率100%。术后平均随访(244.44±90.51)d内,再出血率18.75%,无死亡病例。内镜随访胃静脉曲张消退显著有效6例(42.86%),有效6例(42.86%),无效2例(14.28%),总有效率为85.72%。结论内镜下粘合剂α-氰基丙烯酸烷基酯联合乙氧硬化醇治疗控制瘤状IGV1出血迅速有效,并有望消除胃静脉曲张。

Endoscopic treatment of blue rubber bleb nevus syndrome in a 4-year-old girl with long-term follow-up:A case report

BACKGROUND Blue rubber bleb nevus syndrome(BRBNS)is a rare vascular disease,difficult to diagnose and choose a treatment method,especially in young children.There are several limiting factors to the use of enteroscopy for diagnostics and treatment in pediatric patients,in general.The literature on BRBNS cases is limited and presents various therapeutic approaches.CASE SUMMARY We present here a case of BRBNS involving a 4-year-old female,whose intestinal venous lesions were successfully treated by endoscopic sclerotherapy and aethoxysklerol foam.Skin lesions,typical for BRBNS,appeared on the 8th d of the child’s life and their number increased over the next several months.The child also experienced episodes of critical decrease in hemoglobin level(by as much as 52 g/L)for several years,requiring iron supplementation and several blood transfusions.Video capsule endoscopy revealed numerous vascular formations in the small bowel.The combined findings of gastrointestinal venous formations and skin lesions prompted BRBNS diagnosis.Single-balloon enteroscopy was used to perform sclerotherapy,with aethoxysklerol foam.A positive effect was observed within 19 mo of follow-up.We continue to monitor the patient’s hemoglobin level,every 2 wk,and it has remained satisfactory(>120 g/L).CONCLUSION Endoscopic sclerotherapy can be effective in the clinical management of gastrointestinal manifestations of BRBNS in young children.

内镜下硬化剂注射治疗dieulafoy病出血的疗效观察

目的探讨乙氧硬化醇内镜下注射治疗dieulafoy病出血的疗效。方法对我院2009年到2011年住院的dieulafoy病出血患者,随机分为两组,分别用乙氧硬化醇注射和1:10000肾上腺素注射治疗,分别观察治疗后首次止血成功率和再出血发生率,手术率。结果治疗组的止血成功率均高于对照组;治疗组的再出血发生率均低于对照组组。结论乙氧硬化醇注射治疗dieulafoy病出血达到较好的治疗效果。

Efficacy of endoscopic therapy for gastrointestinal bleeding from Dieulafoy’s lesion

AIM: To investigate the endoscopic hemostasis for gastrointestinal bleeding due to Dieulafoy's lesion. METHODS: One hundred and seven patients with gastrointestinal bleeding due to Dieulafoy's lesion were treated with three endoscopic hemostasis methods: aethoxysklerol injection (46 cases), endoscopic hemoclip hemostasis (31 cases), and a combination of hemoclip hemostasis with aethoxysklerol injection (30 cases). RESULTS: The rates of successful hemostasis using the three methods were 71.7% (33/46), 77.4% (24/31) and 96.7% (29/30), respectively, with signif icant differences between the methods (P < 0.05). Among those who had unsuccessful treatment with aethoxysklerol injection, 13 were treated with hemoclip hemostasis and 4 underwent surgical operation; 9 cases were successful in the injection therapy. Among the cases with unsuccessful treatment with hemoclip hemostasis,7 were treated with injection of aethoxysklerol and 3 cases underwent surgical operation; 4 cases were successful in the treatment with hemoclip hemostasis. Only 1 case had unsuccessful treatment with a combined therapy of hemoclip hemostasis and aethoxysklerol injection, and surgery was then performed. No serious complications of perforation occurred in the patients whose bleeding was treated with the endoscopic hemostasis, and no re-bleeding was found during a 1-year follow-up. CONCLUSION: The combined therapy of hemoclip hemostasis with aethoxysklerol injection is the most effective method for gastrointestinal bleeding due to Dieulafoy's lesion.

下肢网状静脉与毛细血管扩张症的泡沫硬化剂注射治疗

目的探讨下肢网状静脉与毛细血管扩张症的泡沫硬化剂注射治疗效果。方法 2009年1月至2010年1月,经多普勒超声检查排除下肢深、浅静脉瓣膜功能不全后,对125例下肢单纯性网状静脉与毛细血管扩张症患者应用1%乙氧硬化醇(聚桂醇)泡沫法注射治疗。结果 125例患者经硬化剂注射并持续穿着医用弹力袜压迫治疗后,扩张的网状静脉与毛细血管均消失,短期效果满意,患者均无任何严重不良反应。结论乙氧硬化醇泡沫法注射治疗下肢网状静脉与毛细血管扩张症是一种十分安全、简单、经济、有效的方法。

食管硬化剂治疗与门脉高压性胃病

本文前瞻性观察９６例食管胃底静脉曲张出血硬化剂治疗者门脉高压性胃病（ＰＨＧ）的发生率。硬化剂治疗前ＰＨＧ１０例（１０．４％）。１％乙氧硬化醇注射２２７次（４０例注射１次），５６例平均注射３．３３次，其中曲张静脉消退或明显减轻３９例（８８．５％）。结果１例原轻度ＰＨＧ发展成重度ＰＨＧ并大出血，１０例硬化剂注射后（平均８．２５个月）发生ＰＨＧ（１７．８％），每例硬化剂注射平均３．７２次，静脉内注射４９．６ｍｌ，静脉旁１２．５ｍｌ，其中２例发生ＰＨＧ性出血。本研究结果表明，硬化剂治疗后部分患者可发生ＰＨＧ或使原ＰＨ６加重甚至发生出血。

内镜下注射硬化剂治疗食管贲门粘膜撕裂综合症的临床研究(英文)

目的:研究内镜下注射1%乙氧硬化醇和注射1:10 0000肾上腺素治疗食管贲门粘膜撕裂综合症的疗效及安全性。方法:按照随机抽样的原则,从行急诊胃镜检查确诊为食管贲门粘膜撕裂综合症并行内镜下止血治疗的患者中,随机抽取58例患者,按随机数字表法分为治疗组29例和对照组29例,治疗组采用内镜下注射1%乙氧硬化醇,对照组采用内镜下注射1:10 0000肾上腺素,观察两组患者首次止血成功率,早期、近期、远期再出血率,并发症发生率等。结果:治疗组首次止血成功率96.55%(28/29),对照组首次止血成功率93.10%(27/29),两组差异无统计学意义(P>0.05),治疗组早期再出血率7.41%(2/28),显著低于对照组29.63%(8/27)(P<0.05),治疗组近期及远期再出血率为3.57%(1/28),对照组近期及远期再出血率3.70%(1/27),两组差异无统计学意义(P>0.05),两组均无栓塞、穿孔、死亡等并发症出现。结论:内镜下注射乙氧硬化醇治疗食管贲门粘膜撕裂综合症优于注射肾上腺素。

乙氧硬化醇治疗严重食管和胃底静脉曲张出血的疗效观察

本文报告我院对４５例严重食管和胃底静脉曲张破裂出血的患者，用１％乙氧硬化醇血管内注射治疗即硬化疗法（Ａ组），并与内科药物组（Ｂ组）和手术治疗组（Ｃ组）的疗效进行对比。结果Ａ组止血率达９８％，而再出血率Ａ组为１５％，Ｂ组６９％，Ｃ组３２％，三组比较：Ａ组明显低于Ｂ组（Ｐ＜０．０１），与Ｃ组无明显差别（Ｐ＞０．０５）。随访追踪观察：Ａ组５年存活率为７９％，Ｂ组为１９％，Ｃ组为７３％，Ａ组明显高于Ｂ组（Ｐ＜０．０１），与Ｃ组无明显差异（Ｐ＞０．０５）。