内镜下食管胃静脉曲张精准断流术治疗儿童食管胃静脉曲张初步效果评价

摘要

Objective To investigate the effect of the endoscopic selective varices devascularization (ESVD) for the esophageal gastric varices bleeding (EGVB) in children. Methods The clinical data of the patients diagnosed with EGVB and treated with ESVD from January 2018 to March 2018 were retrospectively analyzed. The effects, safety and complications of ESVD were evaluated. Results There were five patients (including 2 males and 3 females, age ranged from 4 to 7 years) in the study. No rebleeding was found at the first follow‐up on one week post operation. Three patients were treated with the endo‐therapy at the twice follow‐up (3 months after surgery): 2 patients had ESVD again and 1 patient had resection under endoscopy due to stenosis caused by surgical scar. After the second procedure, there was no rebleeding but one patient had abdominal pain caused by mesenteric thrombosis, cured with low molecular weight heparin. Conclusion The ESVD for EGVB is safe and effective, but the long‐term curative effect should be further studied.%目的 初步探索内镜下食管胃静脉曲张精准断流术(ESVD)对儿童食管胃静脉曲张的治疗效果.方法 回顾性分析.以2018年1至3月北京儿童医院消化科因消化道出血就诊的,行内镜检查后发现存在食管胃底静脉曲张的5例患儿为研究对象.给予ESVD治疗,对所有患儿进行随访,对ESVD的疗效、安全性及出现的并发症进行评估.结果 5例患儿男2例、女3例,年龄4~7岁,首次内镜(术后1周)复查后食管静脉均可见实变,无出血,无渗血及出血.第2次内镜复查(术后3个月)时有3例再次给予内镜下治疗(2例行精准断流术,1例因食管狭窄行内镜下切开术);2例曲张静脉消失;5例均无再出血情况;1例术后出现肠系膜血栓引起的腹痛,予低分子肝素治疗后逐渐好转.结论 ESVD对食管胃静脉曲张的治疗是安全的、有效的,但其远期疗效仍需进一步研究.