球囊栓堵联合内镜治疗合并门体分流道的胃静脉曲张  

Value of balloon closure combined with endoscopic therapy for gastric varices with portasystemic shunt

作　　者：何占娣 刘迎娣[1] 付来琳 刘博[1] 孙国辉[1] 王娟[1] 孙刚[1] 令狐恩强[1] 

机构地区：[1]解放军总医院消化内科,北京100853

出　　处：《中华消化内镜杂志》2017年第8期560-562,共3页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价球囊栓堵门体分流道联合内镜下组织胶注射对于胃静脉曲张（GV）合并门体分流道的治疗价值。方法2009年1月至2016年2月间，解放军总医院收治的33例GV合并胃－肾分流道（SGRS）或脾－肾分流道（SSRS）且行球囊栓堵联合内镜下组织胶注射治疗的病例资料纳入回顾性分析，对操作完成情况、并发症发生情况及治疗效果进行总结。结果33例GV患者中，合并SGRS28例（84．8％）、SSRS5例（15．2％）。GV治疗前均行球囊逆行分流道阻断术，其中24例（72．7％）成功栓堵，5例SSRS在X线下造影仅1例（20．0％）发现分流道并成功进行分流道球囊栓堵。33例术后均未发生异位栓塞，无感染、肝性脑病、肝功能恶化等并发症，3个多月时内镜复查GV早期排胶21例、未排胶12例。结论对于合并门体分流道的GV患者，使用球囊栓堵门体分流道联合内镜下组织胶注射治疗安全有效。Objective To evaluate the clinical effect of balloon closure combined with endoscopic therapy on spontaneous gastrorenal shunt （SGRS） and spontaneous splenorenal shunt （SSRS）. Methods The data of 33 patients of gastric varices with SGRS or SSRS diagnosed in the Chinese PLA General Hospital between January 2009 and February 2016 were collected. All patients were treated with the balloon retrograde distributary channel blocking technique and endoscopic histoacryl injection. Patients＇ clinical data, complications and effect of endoscopic therapy were retrospectively analyzed. Results In the 33 patients of gastric varices, gastrorenal shunt was found in 28 （ 84. 8% ） eases and splenorenal shunt was found in 5 （15.2%） cases. After the balloon blocking technique, 24 cases （72. 7% ） were occluded successfully. Four cases failed in occlusion of SSRS due to tortuosity. There were no postoperative ectopic embolism, infection, hepatic encephalopathy, liver function deterioration, and other complication. Early latex varices were found in 21 cases after three months follow-up. Conclusion The balloon blocking technique combined with tissue adhesive injection could safely and effectively avoid the risk of ectopic embolism and plays an important role in the treatment of gastric varices in merger portasystemic shunt.

关 键 词：内窥镜 食管和胃静脉曲张 球囊栓堵 门体分流道 

分 类 号：R575.2[医药卫生—消化系统]