胃镜下组织胶注射治疗肝硬化胃静脉曲张破裂出血的疗效评价

摘要

Astract: Objective To explore the efifcacy and safety of endoscopic tissue adhesive injection in treatment of gastric variceal bleeding from liver cirrhosis.Methods Object of study are 92 cirrhotic patients (72 male/20 female) in hospital, who had been diagnosed with gastric varices bleeding from June 2014 to May 2016. Child-Pugh score at presentation for cirrhotic patients was A-28; B-36; C-28. According to endoscopic classiifcation of gastric varices, GEV1 were detected in 80 patients, GEV2 in 12. All patients were treated with endoscopic hypertonic glucose tissue adhesive ‘sandwich’ injection.Result Successful injection rate was 100.0% in 92 patients, among which 40 patients had accepted emergency endoscopic treatment and the immediate hemostasis rate was 100.0%. 65 patients were Having gastroscope review after the injection six months, 22 patients were significantly effective, accounting for 33.8%; 38 patients were effective, accounting for 58.4%; 5 patients were invalid, accounting for 7.7%. All the patients were followed up in 1 to 24 months. The late-rebleeding rate was 2.2%. None of them were having early-rebleeding or dead; Complications the incidence of rebleeding rate which caused by removing the needles which trapped in the varices was 2.2%. The incidence of chest pain rate was 4.3%, the bloating rate was 6.5% and the ulceration rate was 15.2%. There was no complications like fever, infection, stomachache, embolism and so on.Conclusion With low rebleeding rate and light side-effect, endoscopic tissue adhesive injection in the treatment of gastric variceal bleeding caused by cirrhosis portal hypertension has really good effect.%目的：探讨胃镜下组织胶注射治疗肝硬化胃静脉曲张破裂出血的临床疗效及安全性。方法研究对象为2014年6月－2016年5月住院经胃镜确诊的肝硬化胃静脉曲张破裂出血的患者92例。其中，男72例，女20例。92例肝硬化患者的肝功能Child-Pugh分级：A级28例，B级36例，C级28例。胃镜下胃曲张静脉分型：GEV 1型80例，GEV 2型12例。所有患者均采用胃镜下高渗糖组织胶“三明治”夹心法注射治疗。结果①92例肝硬化胃静脉曲张破裂出血的患者胃镜下组织胶注射治疗成功率100.0%，其中急诊胃镜下组织胶注射治疗的患者40例，即时止血率100.0%。65例患者术后6个月复查胃镜：显效22例，占33.8%；有效38例，占58.5%；无效5例，占7.7%。全部患者随访1～24个月，无早期再出血患者，晚期再出血率2.2%，无患者死亡；②并发症：组织胶注射治疗术中拔针出血发生率2.2%，术后胸痛发生率4.3%，腹胀发生率6.5%，排胶溃疡发生率15.2%，无发热、感染、腹痛和异位栓塞等并发症发生。结论胃镜下组织胶注射治疗肝硬化胃静脉曲张破裂出血的疗效确切，止血效果好，不良反应轻，再出血发生率低。