食管与胃/肠吻合术后食管静脉曲张的硬化疗效分析  

Curative effect of endoscopic injection sclerotherapy for esophageal varices after esophago-gastric/intestinal anastomosis

作　　者：李萌[1] 刘迎娣[2] 孙国辉[1] 柴国君[1] 孙刚[1] 杨竞[1] 申少华[1] 高伟[1] 孙潇[1] 

机构地区：[1]解放军总医院消化内科,北京100853 [2]解放军总医院海南分院消化内科

出　　处：《胃肠病学和肝病学杂志》2015年第10期1202-1204,共3页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的评价内镜下硬化治疗（endoscopic injection sclerotherapy,EIS）食管与胃/肠吻合术后食管静脉曲张破裂出血（esophageal varices hemorrhage,EVH）的临床疗效。方法回顾近2年解放军总医院消化内科收治的因EVH住院行EIS的4例患者的临床资料,总结患者一般情况如食管、胃/肠手术术式、肝功能分级、腹水、出血及食管静脉曲张程度等,特别对患者内镜下表现、治疗方法的选择、治疗部位、次数、硬化治疗效果进行回顾性分析。根据患者随访情况,对EV再发出血、复发情况、并发症情况进行临床分析。结果 4例患者年龄35~63岁;其中乙肝肝硬化1例、丙肝肝硬化1例、其他病因肝硬化2例;出血发生于手术治疗后1~21个月;其中食管横断术1例、近端胃癌切除食管胃吻合术后1例、胃全切食管小肠吻合术后2例;其中1例行近吻合口、套扎治疗脱环后均行EIS治疗;平均治疗次数4次;治疗后曲张静脉基本消退,内镜随访平均6个月,1例于12个月内镜复查发现曲张静脉复发并发生再出血,经再次补充治疗后消失;均未发生肝性脑病、食管穿孔、食管狭窄等并发症。结论 EIS治疗食管与胃/肠吻合术后EVH是一种简单易行、安全有效的治疗方法,值得临床推广。Objective To explore the efficacy of endoscopic injection sclerotherapy（ EIS） for esophageal varices hemorrhage（ EVH） after esophago-gastric or esophago-intestinal anastomosis. Methods Four patients with EVH who underwent EIS were included in the Chinese PLA General Hospital. The clinical data were studied retrospectively including general condition such as gastric surgery procedure,Child-Pugh grade of liver function,presence of ascites,hemorrhage and degree of EV. Four cases were followed-up by endoscopy after EIS,including EV recurrent bleeding,recrudescence and complications. Results Four patients were 35 to 63 years old,there were 1 case with HBV cirrhosis,1case with HCV,2 cases with cirrhosis in other diseases; EVH occurred in 1 ~ 21 months after the surgery. Of the 4 patients with esophageal or gastric surgery,there were 1 case with esophageal transection,1 case with the proximal gastric cancer resection and esophago-gastric anastomosis,2 cases with esophago-intestinal anastomosis. All cases were underwent the EIS including one post taking off of tentative ligation near anastomotic. The patients underwent 4 times of endoscopic treatment. One case found recurrence of varicose veins and mild EVH on 12 months endoscopy. Varices re-obliterated after treatment complemetally. No esophageal perforation,severe complications of esophageal stenosis occurred after treatment. Conclusion EIS is a safe and effective treatment for EVH after esophago-gastric or esophago-intestinal anastomosis.

关 键 词：食管静脉曲张 食管与胃/肠吻合术 硬化治疗 

分 类 号：R571.3[医药卫生—消化系统]