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目的探讨胃静脉曲张(GV)合并胃肾或脾肾分流道(SGRS或SSRS)患者经内镜下硬化剂联合组织黏合剂注射治疗的效果。方法选取解放军总医院2008年6月-2013年6月收治的经胃镜及CT检查证实为存在SGRS或SSRS的17例GV患者的临床资料进行回顾性研究,并对内镜下胃静脉曲张硬化剂联合组织黏合剂注射治疗效果进行初步分析。结果 17例患者均因间断呕血、黑便入院。乙肝肝硬化9例,乙肝合并原发性肝癌2例,酒精性肝硬化2例,隐源性肝硬化1例,门脉海绵样变1例,结肠癌术后门静脉系统血栓1例,Wilson氏病1例。胃静脉曲张分型GOV-1型2例,GOV-2型11例,IGV-1型4例,无IGV-2型。胃肾分流道13例,脾肾4例。17例患者均行内镜下硬化剂联合组织黏合剂注射治疗,术后无异位栓塞等并发症发生。结论合并SGRS或SSRS的GV,经内镜下硬化剂联合组织黏合剂注射治疗,在有效治疗GV同时也可最大限度地降低组织黏合剂固化物经分流道致异位栓塞发生的可能性。治疗前应行胃镜及门静脉CT血管成像检查,直观了解胃底静脉曲张情况及其交通支、分流道情况。
Objective To investigate the effect of endoscopic sclerotherapy combined with tissue adhesive injection in patients with gastric varices (GV) and gastric or splenorenal shunt (SGRS or SSRS). Methods A retrospective study was conducted on the clinical data of 17 patients with GV confirmed by gastroscope and CT examination in the General Hospital of PLA from June 2008 to June 2013 and who had SGRS or SSRS. The endoscopic gastric varicosity sclerosing agent Joint adhesive treatment effect of the initial analysis. Results 17 patients were due to intermittent hematemesis, black will be admitted. Hepatitis B cirrhosis in 9 cases, hepatitis B with primary liver cancer in 2 cases, alcoholic cirrhosis in 2 cases, cryptogenic cirrhosis in 1 case, portal vein sponge-like change in 1 case, colon cancer after portal vein thrombosis in 1 case, Wilson’s 1 case of disease. Gastric varices type 2 cases of GOV-1 type, 11 cases of GOV-2 type, 4 cases of IGV-1 type, no IGV-2 type. 13 cases of gastric and renal shunt, spleen and kidney in 4 cases. Seventeen patients underwent endoscopic sclerotherapy combined with tissue adhesive injection. No postoperative complications such as ectopic embolization occurred. Conclusions GV with SGRS or SSRS combined with endoscopic sclerotherapy and tissue adhesive injection can effectively reduce the possibility of GV edema caused by heterotopic embolization of tissue adhesive during the treatment of GV. Before treatment, gastroscopy and portal vein CT angiography should be performed to understand the situation of gastric varices and its traffic branch and shunt.