内镜下组织胶注射治疗区域性门静脉高压致胃底静脉曲张出血的疗效分析  

Efficacy of endoscopic histoacryl injection in treatment of gastric variceal bleeding caused by regional portal hypertension

作　　者：汤善宏[1,2] 曾维政[1] 陈虹彬[1] 李红永[1] 徐辉[1] 范泉水[2] 蒋明德[1] 

机构地区：[1]成都军区总医院消化内科,成都610083 [2]成都军区疾病预防控制中心,成都610083

出　　处：《临床肝胆病杂志》2015年第8期1283-1286,共4页Journal of Clinical Hepatology

摘　　要：目的分析内镜下组织胶注射治疗区域性门静脉高压致胃底静脉曲张出血的效果。方法收集2012年6月-2014年12月于成都军区总医院就诊的6例区域性门静脉高压致胃底静脉曲张破裂出血患者,分析其内镜下特点及组织胶注射治疗后的效果,并与同期在本院接受内镜下组织胶注射治疗的6例乙型肝炎肝硬化门静脉高压胃底静脉曲张破裂出血患者相比较。计数资料组间比较采用Fisher精确检验。结果区域性门静脉高压患者中5例为重度孤立性胃底静脉曲张,1例合并轻度食管静脉曲张;6例肝硬化门静脉高压患者均为重度孤立性胃底静脉曲张,内镜下表现与区域性门静脉高压所致静脉曲张相似。区域性门静脉高压患者短期疗效中有效1例,无效5例;6例乙型肝炎肝硬化门静脉高压患者短期疗效均为有效,两组间差异具有统计学意义(P=0.015);长期疗效中,区域性门静脉高压患者至随访终点所有患者均为无效;乙型肝炎肝硬化门静脉高压患者至随访终点有效5例,无效1例,两组间差异具有统计学意义(P=0.015)。结论区域性门静脉高压致胃底静脉曲张进展快、出血风险大,内镜下组织胶注射治疗效果差。Objective To analyze the efficacy of endoscopic histoacryl injection in the treatment of gastric variceal bleeding caused by regional portal hypertension. Methods The endoscopic features and efficacy of endoscopic histoacryl injection were examined and compared in two groups of patients admitted to our hospital from June 2012 to December 2012. One of the groups included 6 patients with gastric variceal bleeding caused by regional portal hypertension and the other group included 6 patients with gastric variceal bleeding caused by hepatitis B cirrhosis- related portal hypertension. Between- group comparison of categorical data was made by Fisher＇ s test. Results In patients with regional portal hypertension,five of them had severe isolated gastric varices（ IGV） and one had severe IGV with mild esophageal varices. All six patients with hepatitis B cirrhosis- related portal hypertension had severe IGV and the endoscopic features were similar to those of patients with regional portal hypertension. Significant differences were observed between the group with regional portal hypertension and the group with hepatitis B cirrhosis related portal hypertension in short- term response rate（ 1 /6 vs 6 /6,P = 0. 015） and long- term response rate（ 0 /6 vs 5 /6,P = 0. 015）. Conclusion The gastric varices caused by regional portal hypertension has a fast progression rate and a high bleeding risk. The efficacy of endoscopic histoacryl injection in patients with this type of gastric varices is poor.

关 键 词：肝硬化 高血压 门静脉 食管和胃静脉曲张 硬化疗法 

分 类 号：R575.2[医药卫生—消化系统]