获得性免疫缺陷综合征合并肝硬化食管胃静脉曲张破裂出血的内镜诊疗分析

Endoscopic diagnosis and treatment of esophagogastric variceal bleeding in AIDS patients with cirrhosis

摘要:

目的 探讨获得性免疫缺陷综合征（AIDS）合并肝硬化食管胃静脉曲张破裂出血（EVB）的内镜诊疗效果及相关并发症。方法 回顾性分析2020年4月1日－2025年12月31日于该院接受内镜诊治的13例AIDS合并肝硬化EVB患者的临床资料，观察内镜诊疗效果及术后相关并发症发生情况。结果 13例患者均完成内镜下食管胃静脉曲张治疗。其中，3例患者行内镜下曲张静脉套扎术（1例患者接受内镜下曲张静脉套扎术治疗后，再行超声内镜引导下脾动脉栓塞术及超声内镜引导下门静脉压力梯度测定术），3例患者接受胃静脉曲张内镜组织胶注射术联合食管静脉曲张内镜硬化剂注射术，4例患者行超声内镜引导下胃静脉曲张精准断流术，1例患者接受胃静脉曲张超声内镜引导下弹簧圈栓塞术，2例患者接受超声内镜引导下胃旁静脉曲张精准断流术。所有患者均未发生穿孔及异位栓塞等严重并发症。随访期间，2例患者出现食管胃静脉曲张再出血，经超声内镜引导下精准断流术治疗后好转，2例患者术后出现发热，考虑与脾梗死及败血症相关。结论 AIDS合并肝硬化EVB的患者，可通过个体化内镜诊疗获得较好的近期疗效，但术后仍需关注发热和出血等相关并发症。同时，应严格执行内镜清洗消毒规范，以降低院内感染风险，保障医疗安全。

Abstract:

Objective To evaluate the outcomes and complications of endoscopic diagnosis and treatment for esophagogastric variceal bleeding (EVB) in patients with acquired immunodeficiency syndrome (AIDS) complicated by cirrhosis.Methods Clinical data of 13 patients with AIDS complicated by cirrhosis and EVB who underwent endoscopic procedures at Hangzhou Xixi Hospital from April 1, 2020, to December 31, 2025, were retrospectively analyzed. Endoscopic treatment outcomes and postoperative complications were evaluated.Results All 13 patients completed endoscopic treatment for esophagogastric varices. Among them, 3 patients underwent endoscopic variceal ligation (EVL) (1 patient underwent EUS-guided splenic artery embolization with portal pressure gradient measurement after EVL), 3 patients underwent endoscopic tissue glue injection of gastric varices combined with endoscopic sclerosing agent injection for esophageal varices, 4 patients underwent endoscopic ultrasound (EUS)-guided precise disconnection of gastric varices, 1 patient underwent EUS-guided coil placement, 2 patients underwent EUS-guided precise disconnection of peravenous varices. No severe complications, such as perforation or ectopic embolization occurred. During follow-up, rebleeding from esophagogastric varices occurred in 2 patients, which resolved after EUS-guided precise disconnection. Postoperative fever occurred in 2 patients, which was considered related to splenic infarction and septicemia.Conclusion Individualized endoscopic diagnosis and treatment may achieve favorable short-term outcomes in AIDS patients with cirrhosis and EVB. However, close attention should be paid to complications such as fever and rebleeding. Strict adherence to endoscope reprocessing protocols is essential to reduce the risk of nosocomial infection and ensure medical safety.