内镜下金属夹联合组织胶治疗合并特殊分流道的孤立性胃底静脉曲张临床疗效分析(1)
[摘要] 目的 探討内镜下金属夹联合组织胶治疗合并特殊分流道(脾肾分流或胃肾分流)孤立性胃底静脉曲张疗效及安全性。 方法 回顾性分析2016年8月～2019年9月北京地坛医院及黑龙江省医院肝硬化合并孤立性胃底静脉曲张出血患者共12例，行内镜下金属夹联合组织胶注射治疗。观察记录术中留置金属夹数量及组织胶用量、术后1周复查及补充治疗情况;术后3个月复查及补充治疗情况，并评价内镜下静脉曲张消退情况、术中出血及并发症发生情况。 结果 12例患者均顺利完成治疗，其中4例留置金属夹1枚，6例留置金属夹2枚，1例留置金属夹3枚，1例留置金属夹7枚;首次治疗组织胶总用量2.0～5.5 mL。术后1周复查胃镜，其中8例血管完全实变，暂未进一步处理，其余4例，再次补充组织胶治疗0.5～2.0 mL。术后3个月复查胃镜，其中9例患者静脉曲张完全消失，治愈率75%(9/12)，其余3例基本消失，再次补充组织胶治疗0.5 mL。无一例术中及术后出血，无一例异位栓塞。 结论 内镜下金属夹联合组织胶治疗合并特殊分流道的孤立性胃底静脉曲张是安全有效的方法，可以降低术中出血及异位栓塞风险，同时减少组织胶用量。
[关键词] 金属夹;组织粘合剂;孤立性胃底静脉曲张;脾肾分流;胃肾分流
[中图分类号] R575.2 [文献标识码] A [文章编号] 1673-9701(2020)17-0025-04
An analysis of clinical efficacy of endoscopic metal clip combined with tissue adhesive in the treatment of isolated gastric fundal varices complicated with special shunt
LI Qiang1 LI Ping2 XU Xiaohong1 XUE Hongpeng1 LU Yixia1 REN Xu1
1.Department of Gastroenterology， Digestive Disease Hospital， Heilongjiang Provincial Hospital Affiliated to Harbin Institute of Technology， Harbin 150001， China; 2.Department of Gastroenterology， Beijing Ditan Hospital， Beijing 100020， China
[Abstract] Objective To explore the efficacy and safety of endoscopic metal clip combined with tissue adhesive in the treatment of isolated gastric fundal varices complicated with special shunt(spleno-renal shunt or gastro-renal shunt). Methods 12 patients with liver cirrhosis complicated with isolated variceal hemorrhage of gastric fundus in Beijing Ditan Hospital and Heilongjiang Provincial Hospital from August 2016 to September 2019 were retrospectively analyzed and treated with endoscopic metal clip combined with tissue adhesive injection. The number of metal clips retained and the dosage of tissue adhesive administered during the operation， reexamination and supplementary treatment 1 week after the operation， and reexamination and supplementary treatment 3 months after the operation were observed and recorded. The endoscopic variceal regression， intraoperative hemorrhage and complications were evaluated. Results All the 12 patients successfully completed the treatment， including 4 cases with 1 metal clip retained， 6 cases with 2 metal clips retained， 1 case with 3 metal clips retained and 1 case with 7 metal clips retained. The total dosage of tissue adhesive used for the first treatment was 2.0-5.5 mL. The gastroscopy reexamination 1 week after the operation showed that 8 patients had complete consolidation of blood vessels， and they received no further treatment temporarily; the remaining 4 patients were retreated with another 0.5-2.0 mL of tissue adhesive. The gastroscopy reexamination 3 months after the operation showed that among the 12 patients， 9 patients had complete disappearance of varices， with a curative ratio of 75%(9/12); the remaining 3 patients had the disappearance of most of the varices， and were treated with another 0.5 mL of tissue adhesive. There was no intraoperative or postoperative hemorrhage and no ectopic embolism. Conclusion Endoscopic metal clip combined with tissue adhesive is a safe and effective method for the treatment of isolated gastric fundal varices with special shunt， which can reduce the risks of intraoperative hemorrhage and ectopic embolism， and decrease the dosage of tissue adhesive., 百拇医药(李强 李坪 徐晓红 薛鸿鹏 陆以霞 任旭)
[关键词] 金属夹;组织粘合剂;孤立性胃底静脉曲张;脾肾分流;胃肾分流
[中图分类号] R575.2 [文献标识码] A [文章编号] 1673-9701(2020)17-0025-04
An analysis of clinical efficacy of endoscopic metal clip combined with tissue adhesive in the treatment of isolated gastric fundal varices complicated with special shunt
LI Qiang1 LI Ping2 XU Xiaohong1 XUE Hongpeng1 LU Yixia1 REN Xu1
1.Department of Gastroenterology， Digestive Disease Hospital， Heilongjiang Provincial Hospital Affiliated to Harbin Institute of Technology， Harbin 150001， China; 2.Department of Gastroenterology， Beijing Ditan Hospital， Beijing 100020， China
[Abstract] Objective To explore the efficacy and safety of endoscopic metal clip combined with tissue adhesive in the treatment of isolated gastric fundal varices complicated with special shunt(spleno-renal shunt or gastro-renal shunt). Methods 12 patients with liver cirrhosis complicated with isolated variceal hemorrhage of gastric fundus in Beijing Ditan Hospital and Heilongjiang Provincial Hospital from August 2016 to September 2019 were retrospectively analyzed and treated with endoscopic metal clip combined with tissue adhesive injection. The number of metal clips retained and the dosage of tissue adhesive administered during the operation， reexamination and supplementary treatment 1 week after the operation， and reexamination and supplementary treatment 3 months after the operation were observed and recorded. The endoscopic variceal regression， intraoperative hemorrhage and complications were evaluated. Results All the 12 patients successfully completed the treatment， including 4 cases with 1 metal clip retained， 6 cases with 2 metal clips retained， 1 case with 3 metal clips retained and 1 case with 7 metal clips retained. The total dosage of tissue adhesive used for the first treatment was 2.0-5.5 mL. The gastroscopy reexamination 1 week after the operation showed that 8 patients had complete consolidation of blood vessels， and they received no further treatment temporarily; the remaining 4 patients were retreated with another 0.5-2.0 mL of tissue adhesive. The gastroscopy reexamination 3 months after the operation showed that among the 12 patients， 9 patients had complete disappearance of varices， with a curative ratio of 75%(9/12); the remaining 3 patients had the disappearance of most of the varices， and were treated with another 0.5 mL of tissue adhesive. There was no intraoperative or postoperative hemorrhage and no ectopic embolism. Conclusion Endoscopic metal clip combined with tissue adhesive is a safe and effective method for the treatment of isolated gastric fundal varices with special shunt， which can reduce the risks of intraoperative hemorrhage and ectopic embolism， and decrease the dosage of tissue adhesive., 百拇医药(李强 李坪 徐晓红 薛鸿鹏 陆以霞 任旭)