内镜下钛夹辅助组织胶联合聚桂醇治疗合并胃肾或脾肾分流道的胃底静脉曲张*

Clinical value of endoscopic clipping assisted tissue adhesive combined with lauromacrogol for gastric varices with spontaneous gastrorenal shunt or splenorenal shunt*

摘要:

评价内镜下钛夹辅助组织胶联合聚桂醇治疗合并胃肾或脾肾分流道的胃底静脉曲张的价值。方法?选取2016年6月－2018年6月该院收治的32例胃底静脉曲张合并胃肾分流道或脾肾分流道患者的病历资料，患者均行内镜下钛夹辅助组织胶联合聚桂醇治疗。结果?32例胃底静脉曲张患者中，合并胃肾分流道25例（78.12%）、脾肾分流道7例（21.88%）。32例患者内镜下钛夹辅助组织胶联合聚桂醇治疗均成功，术中每例平均使用钛夹（2.32±1.12）枚，平均注射组织胶（3.67±1.85）ml，平均使用聚桂醇（12.61±6.80）ml。术后均未发生异位栓塞，无肝功能恶化、肝性脑病等并发症，术后6个月内镜复查30例，见排胶27例（90.00%），曲张静脉完全消除者25例（83.33%），部分残留者5例（16.67%）。结论?对于合并门体分流道的胃底静脉曲张患者，使用内镜下钛夹辅助组织胶联合聚桂醇治疗可有效避免异位栓塞的危险，安全简便，疗效佳，值得临床推广应用。

Abstract:

To evaluate the clinical effect of endoscopic clipping assisted tissue adhesive combined with lauromacrogol for gastric varices with spontaneous gastrorenal shunt or splenorenal shunt. Methods Clinical data of 32 patients of gastric varices with spontaneous gastrorenal shunt or splenorenal shunt from June 2016 to June 2018 were collected. All the patients were treated with endoscopic clipping assisted tissue adhesive combined with lauromacrogol. Results In the 32 patients of gastric varices, gastrorenal shunt was found in 25 (78.12%) cases and splenorenal shunt was found in 7 (21.88%) cases. The treatments were completed successfully. Average using of clips was (2.32 ± 1.12), average tissue adhesive dosage was (3.67 ± 1.85) ml, average lauromacrogol dosage was (12.61 ± 6.80) ml. There were no postoperative ectopic embolism, liver function deterioration, hepatic encephalopathy, and other complication.30 patients underwent endoscopic re-examination 6 months after treatment, 27 patients (90.00%) of removing glue, 25 cases (83.33%) achieved varicose vein elimination, 5 cases (16.67%) remained residual. Conclusion The endoscopic clipping assisted tissue adhesive combined with lauromacrogol injection could effectively avoid the risk of ectopic embolism and important role in the treatment of gastric varices in merger portasystemic shunt, and it is safe and simple, which is worthy of clinical application.