超声内镜引导下胃旁曲张静脉精准断流术治疗食管胃静脉曲张出血的疗效分析（附20例报告）

Analysis of the therapeutic effect of precise disconnection of pargastric varices guided by endoscopic ultrasound for the treatment of esophagogastric variceal bleeding (20 cases)

摘要:

目的 探讨超声内镜引导下胃旁曲张静脉精准断流术治疗食管胃静脉曲张出血的疗效。方法 回顾性分析2024年1月1日－2024年12月31日于该院接受超声内镜引导下胃旁曲张静脉精准断流术治疗的20例肝硬化食管胃静脉曲张出血患者的临床资料，并评估治疗效果。结果 20例患者均顺利完成超声内镜引导下胃旁曲张静脉精准断流术；注射组织胶联合置入弹簧圈（16例）和单独注射组织胶（4例）均成功阻断胃旁来源的曲张静脉；所有患者均未发生穿孔、食管贲门狭窄、大出血、败血症和异位栓塞。1例单独注射组织胶的患者，术后胃旁曲张静脉少许渗血，经降低门静脉压力治疗3 d后好转，另1例单独注射组织胶患者，术后出现低热，抗感染3 d后体温恢复正常。结论 超声内镜引导下胃旁曲张静脉精准断流术治疗食管胃静脉曲张出血的临床疗效好，异位栓塞、大出血、感染和穿孔等并发症少，但仍需要密切随访，观察胃旁曲张静脉的排胶问题。

Abstract:

Objective To explore the therapeutic effect of precise disconnection of pargastric varices guided by endoscopic ultrasound in the treatment of esophagogastric variceal bleeding.Method A retrospective analysis was conducted on 20 patients with cirrhosis esophagogastric variceal bleeding treated with endoscopic ultrasound-guided precise disconnection of pargastric varices from January 1, 2024 to December 31, 2024. The efficacy was analyzed.Result All 20 patients successfully completed the precise disconnection of pargastric varices under the guidance of endoscopic ultrasound. The injection of tissue gel combined with the placement of spring coils (14 cases) and the injection of tissue gel alone (4 cases) successfully blocked the pargastric varices. All patients did not experience perforation, esophageal and cardia stenosis, massive bleeding, septicemia, or ectopic embolization. One patient who received tissue gel alone had slight bleeding from the pargastric varices after surgery and improved after 3 days of treatment to reduce portal vein pressure. Another one patient who received tissue gel alone had a low-grade fever and normal body temperature after 3 days of anti - infection treatment.Conclusion Precise disconnection of pargastric varices under the guidance of endoscopic ultrasound has a good therapeutic effect on esophagogastric variceal bleeding, with fewer complications such as ectopic embolization, massive bleeding, infection, and perforation. However, close follow-up observation is still needed to address the issue of pargastric varices.