摘要
目的总结合并胃肾分流道的胃静脉曲张临床诊疗经验。方法回顾性分析解放军总医院第一医学中心消化内科医学部2016年1月至2021年12月期间收治的合并胃肾分流道的胃静脉曲张患者的临床资料。结果共纳入患者30例,男13例、女17例,平均年龄(56.7±8.62)岁,孤立性胃静脉曲张9例、伴食管静脉曲张者21例,病因均为肝硬化所致门静脉高压,Child-Pugh A级8例、Child-Pugh B级21例、Child-Pugh C级1例,门静脉主干直径(11.8±2.33)mm,胃肾分流道最宽处直径(13.7±4.74)mm。所有患者均成功进行了数字减影血管造影(DSA)下胃肾分流道球囊临时封堵术联合内镜下胃静脉曲张组织胶注射治疗,9例合并食管静脉曲张的患者同时行食管静脉曲张套扎治疗。术后3例患者出现发热,5例患者出现腹痛不适,所有患者均未出现组织胶异位栓塞的情况(0.0%)。术后1年内再发出血率6.7%、生存率为100%。结论对于合并胃肾分流道的胃静脉曲张患者,联合DSA下胃肾分流道球囊临时封堵术,可有效降低内镜下组织胶注射治疗时异位栓塞的风险。
Objective To summarize the clinical experience for the management of gastric varices patients combined with gastrorenal shunts.Methods Clinical data of gastric varices patients combined with gastrorenal shunts,who were admitted to the Department of Gastroenterology of the First Medical Center of the PLA General Hospital between January 2016 and December 2021,were analyzed retrospectively.Results A total of 30 patients were enrolled,including 13 males and 17 females,with an average age of(56.7±8.62)years.9 patients were isolated gastric varices,and the other 21 patients were combined with esophageal varices.Portal hypertension was due to cirrhosis in all patients.8 patients were Child-Pugh grade A in liver function,21 were Child-Pugh grade B,and 1 was Child-Pugh grade C.The average diameter of the portal veins was(11.8±2.33)mm,and the average maximum diameter of the gastrorenal shunts was(13.7±4.74)mm.All patients were successfully treated with combined endoscopic cyanoacrylate injection and balloon temporary occlusion of gastrorenal shunts.9 of the patients combined with esophageal varices underwent variceal ligation at the same time.None of the patients occured ectopic embolization after the operation,and only 3 patients had fever,and 5 patients had abdominal pain or discomfort.The rebleeding rate was 6.7%within 1 year,and the survival rate was 100%.Conclusion Combined endoscopic cyanoacrylate injection and balloon temporary occlusion of gastrorenal shunts is suitable for gastric variceal patients with gastrorenal shunts.It can effectively reduce the risk of ectopic embolism.
作者
张晓彬
刘迎娣
王娟
孙国辉
钟立森
何占娣
令狐恩强
ZHANG Xiao-bin;LIU Ying-di;WANG Juan;SUN Guo-hui;ZHONG Li-sen;HE Zhan-di;LINGHU En-qiang(Department of Gastroenterology,The First Medical Center of Chinese PLA General Hospital,Fuxing Road NO.28,Haidian District,Beijing,100853,China)
出处
《现代消化及介入诊疗》
2023年第7期803-808,共6页
Modern Interventional Diagnosis and Treatment in Gastroenterology
基金
国家重点研发计划(2022YFC2503606)。
关键词
胃静脉曲张
胃肾分流道
组织胶注射术
球囊封堵术
异位栓塞
Gastric varices
Gastrorenal shunt
Endoscopic cyanoacrylate injection
Balloon occlusion
Ectopic embolization
