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目的总结内镜下套扎并联合注射组织粘合剂治疗重度食管胃底静脉曲张破裂出血的疗效。方法对经内镜下连续套扎术治疗的重度食管胃底静脉曲张破裂出血 2 3例 ,及经套扎术后诱发加重的 4例胃底静脉曲张破裂出血者联合内镜下组织粘合剂注射治疗的临床资料进行回顾性分析。结果 2 3例套扎治疗者 ,平均每例套扎 1.8次 ,共行 42例次 198处套扎 ,显效 13例 (5 6.6% ) ,有效 9例(3 9.1% ) ,其中 6例大出血经急诊镜下套扎后即获止血 ,并发大出血失败 1例 (4 .3 % ) ,总有效率 95 .7%。 4例患者分别于食管曲张静脉套扎术后第 4～ 12周出现 ～ 级胃底静脉曲张 (发生率 17.4% ) ,经联合注射组织粘合剂治疗后静脉曲张消失 ,6个月后胃镜复查 ,组织粘合剂完全排出 ,未再出血。结论内镜套扎治疗重度食管静脉曲张破裂出血疗效显著。对套扎后诱发加重的胃底静脉曲张破裂出血 ,联合镜下组织粘合剂注射效果满意
Objective To summarize the curative effect of endoscopic ligation combined with injection of tissue adhesive in the treatment of severe esophageal variceal bleeding. Methods Twenty-three cases of severe esophageal and gastric variceal bleeding treated by endoscopic ligation and 4 cases of gastric variceal bleeding after ligation were treated with endoscopic tissue adhesive The clinical data of injection therapy were retrospectively analyzed. Results Twenty-three patients underwent ligation in an average of 18 cases. Twenty-two of the 42 cases were ligated in 198 cases, markedly effective in 13 cases (5 6.6%) and effective in 9 cases (3 9.1%), of which 6 cases had massive bleeding Embolization of the emergency department was stopped after hemostasis, bleeding complicated by failure in 1 case (4.3%), the total effective rate was 95.7%. Four patients had ~ grade gastric varices (incidence rate 17.4%) at 4th to 12th week after esophageal varicose vein ligation respectively. The varicose veins disappeared after the combination of tissue adhesive treatment, and the endoscopy was performed after 6 months Tissue adhesive was completely removed without further bleeding. Conclusion Endoscopic ligation is effective in treating severe esophageal variceal bleeding. After ligation of gastric varices induced bleeding aggravated, combined microspheres tissue adhesive injection results satisfactory