超声内镜在胃底静脉曲张组织胶治疗后再出血的治疗探索  

Application of endoscopic ultrasound-guided therapy in rebleeding after gastric varices glue injection

作　　者：王俊雄[1] 吴咏冬[1] 王拥军[1] 宗晔[1] 牛应林[1] 张澍田[1] 李鹏[1] WANG Junxiong;WU Yong-dong;WANG Yong-jun;ZONG Ye;NIU Ying-lin;ZHANG Shu-tian;LI Peng(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases,National Clinical Research Centre for Digestive Diseases,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院消化内科,国家消化系统疾病临床医学研究中心,消化疾病癌前病变北京市重点实验室,北京100050

出　　处：《中国实用内科杂志》2022年第10期851-854,共4页Chinese Journal of Practical Internal Medicine

基　　金：北京市医管局消化协同中心特色项目(XXT05)。

摘　　要：目的探讨超声内镜引导组织胶注射或联合弹簧圈栓塞治疗胃静脉曲张组织胶治疗后再出血的疗效及安全性。方法纳入2016年12月至2022年6月在首都医科大学附属北京友谊医院接受超声内镜引导下治疗的胃底静脉曲张组织胶治疗后再出血的患者。主要评价指标为术后曲张静脉团内血流消失情况及再出血率,次要指标包括弹簧圈栓塞的安全性和患者生存情况。结果共16例胃静脉曲张再出血患者纳入研究,其中男9例、女7例,年龄(57.3±8.0)岁。内镜超声检查提示靶血管最大内径为44 mm,置入弹簧圈数量为(1.5±0.5)个。患者操作完成后均经多普勒辅助确认血流完全消失。中位随访时间14.2个月,2例患者发生再出血,术后1年再出血率为12.5%;1例患者死亡,术后1年病死率为6.25%。结论内镜超声引导下治疗是胃静脉曲张组织胶治疗后再出血的安全有效治疗方法。Objective To investigate the efficacy and safety of endoscopic ultrasound-guided glue or combined with coil injection in the treatment of rebleeding after gastric varices glue injection.Methods Patients who underwent endoscopic ultrasound-guided treatment with post-cyanoacrylate gastric variceal rebleeding in Beijing Friendship Hospital Capital Medical University from December 2016 to June 2022 were included in the study.The main evaluation indicators were the disappearance of blood flow in the varices after operation and the rebleeding rate.Secondary outcomes included safety of coil embolization and patient survival.Results A total of 16 patients with gastric varices rebleeding were included in the study,including 9 males and 7 females,age of(57.3±8.0)years.Endoscopic ultrasonography showed that the maximum inner diameter of the target vessel was 44 mm,and the number of coils was 1.5±0.5.After the operation,all patients were confirmed by Doppler assistance to confirm the complete disappearance of blood flow.The median follow-up time was 14.2months.Rebleeding occurred in 2 patients,and the 1-year rebleeding rate was 12.5%;1 patient died,and the 1-year mortality rate was 6.25%.Conclusion Endoscopic ultrasound-guided therapy may be an effective treatment for postcyanoacrylate gastric variceal rebleeding.

关 键 词：胃底静脉曲张 再出血 内镜超声 弹簧圈 组织胶 

分 类 号：R573[医药卫生—消化系统]