金属夹辅助内镜超声引导组织胶注射治疗合并胃肾分流的肝硬化胃静脉曲张患者的效果初探  

The preliminary therapeutic effect of endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips in treatment of cirrhotic patients with gastric varices and gastric-renal shunt

作　　者：马佳丽[1] 艾正琳[1] 胡居龙[1] 蒋煜[1] 周玉玲[1] 梁秀霞[1] 魏红山[1] 李坪[1] MA Jiali;AI Zhenglin;HU Julong;JIANG Yu;ZHOU Yuling;LIANG Xiuxia;WEI Hongshan;LI Ping(Department of Gastroenterology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院消化内科,北京100015

出　　处：《临床肝胆病杂志》2024年第4期734-738,共5页Journal of Clinical Hepatology

基　　金：北京市属医院科研培育计划项目(PX2023065)。

摘　　要：目的探讨金属夹辅助内镜超声引导组织胶注射治疗合并胃肾分流的胃静脉曲张患者的效果及安全性。方法纳入2023年2月—2023年6月因肝硬化伴胃静脉曲张于首都医科大学附属北京地坛医院就诊,证实存在胃肾分流(GRS),并接受金属夹辅助内镜超声引导组织胶注射治疗的患者。主要的评价指标是术后曲张静脉减轻或消失情况,次要评价指标为手术完成情况及并发症。结果共11例合并GRS的胃静脉曲张患者纳入研究,男7例,女4例;中位年龄55岁;肝功能Child-Pugh A级1例,Child-Pugh B级7例,Child-Pugh C级3例;分流道最大直径(中位)8 mm,最小直径(中位)4 mm。治疗前靶血管血流中位流速11 cm/s,金属夹阻断后靶血管中位流速5 cm/s;中位组织胶使用量2 mL,聚桂醇使用量均为1 mL。所有患者手术结束后血流信号100%消失,手术成功率100%。随访6周患者均无再出血发生。术后1个月复查胃镜示静脉曲张根除或基本消失9例,静脉曲张改善2例。结论对于合并GRS的胃静脉曲张肝硬化患者,金属夹辅助内镜超声引导组织胶注射治疗是一种可行,安全,有效的方法。Objective To investigate the safety and efficacy of endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips in the treatment of cirrhotic patients with gastric varices and gastric-renal shunt(GRS).Methods The patients who attended Beijing Ditan Hospital,Capital Medical University,due to liver cirrhosis and gastric varices from February to June 2023 were enrolled,and all patients were confirmed to have GRS and received endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips.The primary evaluation index was alleviation or disappearance of varicose veins after surgery,and the secondary evaluation indices were surgical completion and complications.Results A total of 11 patients were enrolled in this study,among whom there were 7 male patients and 4 female patients,with a median age of 55 years.Of all patients,1 had Child class A liver function,7 had Child class B liver function,and 3 had Child class C liver function.The maximum(median)diameter of the shunt was 8 mm,and the minimum(median)diameter of the shunt was 4 mm.The median blood flow velocity of the target vessel was 11 cm/s before treatment and 5 cm/s after occlusion with metal clips.The median amount of tissue adhesive injected was 2 mL,and the amount of lauromacrogol used was 1 mL.Disappearance of blood flow signals was observed in all patients after surgery(100%),and the success rate of surgery was 100%.No patient experienced rebleeding after follow-up for 6 weeks.Gastroscopy at 1 month after surgery showed that gastric varices were eradicated or almost disappeared in 9 patients and were alleviated in 2 patients.Conclusion Endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips is a feasible,safe,and effective treatment method for cirrhotic patients with gastric varices and GRS.

关 键 词：肝硬化 食管和胃静脉曲张 金属夹 

分 类 号：R575.2[医药卫生—消化系统]