鱼肝油酸钠、纤维蛋白原、凝血酶序贯治疗胃底静脉曲张出血  

Sequential therapy on gastric fundus varicosis and hemorrhage with sodium morrhuate,fibrinogen,and thrombin

作　　者：冯凯祥[1] 黄晓丽[1] 杨培[1] 刘小英[1] 赵红[1] 张献文[1] 竹建强[1] 

机构地区：[1]四川省绵阳市中心医院内镜中心,四川绵阳621000

出　　处：《西南国防医药》2013年第7期703-705,共3页Medical Journal of National Defending Forces in Southwest China

基　　金：2001年绵阳市卫生局科研项目(200105)

摘　　要：目的探讨鱼肝油酸钠、纤维蛋白原、凝血酶序贯治疗胃底静脉曲张出血的价值。方法 80例胃底静脉曲张患者,在曲张静脉血管破口附近进针,每次注射1～4点,每点快速注射5%鱼肝油酸钠2～6 ml、纤维蛋白原2～3 ml、凝血酶2.5～3 ml(50 U/ml),短暂留针后拔针。注破口处喷血停止后,处理其他静脉,治疗后1 w复查胃镜;隔4 w后做第2次注射,直至曲张静脉消失。合并食管静脉曲张的,给予套扎。结果 80例急诊注射总308点,急诊止血率100%;首次治疗1 w后复查内镜:65例静脉曲张较治疗前缩小,15例胃静脉消失。复查见18例注射点轻度糜烂,3例浅溃疡。80例完成择期治疗总183次;其中55例完成食管静脉套扎112次。择期治疗后胃镜示:胃底静脉为F069例,F111例。本组随访20～24个月,失访5例,随访期间有15例再发出血,其中6个月内再出血2例,12个月内再出血5例,24个月内再出血8例;随访期间死亡5例,3例死于慢性肝衰,2例死于肝癌,1例死于出血。术后均有不同程度疼痛,发热2例,均予对症处理缓解。结论鱼肝油酸钠、纤维蛋白原、凝血酶栓塞硬化胃底静脉曲张操作方便、安全可靠。Objective To discuss the clinical value of sequential therapy on gastric fundus varicosis and hemorrhage with sodium morrhuate,fibrinogen,and thrombin.Methods Eighty patients with fundus varicosis accepted 1-4 point injection near the rupture of varicose vein.Each point was injected with 2-6 ml 5% sodium morrhuate,2-3 ml fibrinogen,and 2.5-3 ml（50 U / ml） thrombin.The needle was remained for 6-8 s and then pulled out quickly.Other varicose veins were treated when rupture stopped bleeding.One week after the treatment,the patients were reexamined by gastroscope.Four week later,they received the second-time injection,and the treatment continued until the disappearance of the varicose veins.The patients combined with esophageal varices received the loop ligature treatment.Results The 80 cases received totally 308 points of emergency injection,and the emergency hemostasis rate was 100%.One week after the first-time treatment,the reexamination by endoscopy was carried out.It was found that varicose veins of 65 cases decreased and the vena gastrica of 15 cases disappeared.But mild erosion of injection points occurred in 18 cases,and 3 ones had superficial ulcer.The 80 cases completed 183 times of selective treatment,in which 55 ones completed 112 times of esophageal vein loop ligature.The endoscopic examination results that fundus veins were F0 in 69 cases and F1 in 11 ones after the selective treatment indicated.The follow-up was carried out for 20-24 months,and 5 ones were out of touch.During the follow-up,rehaemorrhagia occurred in 15 cases in which rebleeding occurred within 6 months,in 5 ones within 12 months,and in 8 ones within 24 months.During the follow-up,3 ones died of chronic hepatic failure,2 ones died of liver cancer and one case died of haemohrrhage.All the 80 cases had different degrees of pain,and 2 cases had a fever.But all the symptoms relieved after the symptomatic treatment.Conclusion The treatment with sodium morrhuate,fibrinogen,and thrombin on fundus varicosis is easy,safe,and reliable.

关 键 词：胃底静脉曲张 出血 鱼肝油酸钠 纤维蛋白原 凝血酶 

分 类 号：R657.31[医药卫生—外科学]