内镜下钛夹联合组织胶治疗GOV2 型胃底静脉曲张30 例*

摘要： 目的 总结该院30 例应用内镜下钛夹联合组织胶预防和治疗GOV2 型胃底静脉曲张的临床经 验，初探钛夹辅助治疗的临床应用价值。方法 收集该院2015 年5 月-2016 年12 月GOV2 型胃底静脉曲张 患者病例资料（包括急性出血和一级预防）30 例行病例分析，分析钛夹辅助治疗对术中组织胶注射、术中出 血、术后静脉消除、再出血结局，以及排胶出血、异位栓塞发生的影响。结果 术中平均组织胶用量（1.46± 0.70）ml，平均钛夹用量5 或6 个，术中拔针出血2 例（6.7%）。术后共14 例患者（46.7%）行内镜下复查，静 脉消除者3 例（10.0%），残留者11 例（36.7%）；随访期内再出血4 例（13.3%），死亡2 例（6.7%），1 例为术 后呕血，失血性休克死亡；另1 例术后发生自发性腹膜炎，感染性休克死亡。总体疗效看，治愈2 例（6.7%）， 好转22 例（73.3%），未愈6 例（20.0%，包括再出血4 例，死亡2 例）；术后17 例患者行门静脉CT 血管成像 检查，无1 例发生异位栓塞。术后排胶出血1 例（3.3%），余患者无严重术后并发症发生。结论 内镜下钛夹 联合组织胶可应用于预防、治疗GOV2 型胃底静脉曲张，或可提高治疗效果，降低术中（或）术后出血、异 位栓塞风险，具有良好的临床应用价值，值得进一步临床研究。
Abstract: Objective To summarize clinical experience and explore application value of endoscopic clipping with histoacryl using in management of type 2 gastroesophageal varices. Methods Clinical data of 30 patients with type 2 gastroesophageal varices patients (including acute hemorrhage and primary prevention) from May 2015 to December 2016 were collected. Then evaluate therapeutic effect and safety of endoscopic clipping adjuvant therapy. Results Average glue dosage was (1.46 ± 0.70) ml, average using of clips were (5 ~ 6), and intraoperative needle pulling hemorrhage occurred in 2 cases. 14 patients (46.7%) underwent endoscopic re-examination, 3 patients (10.0%) achieved varicose vein elimination, 11 cases (36.7%) remained residual. Rebleeding occurred in 4 cases (13.3%), and 2 cases died (6.7%), one because of postoperative hematemesis and hemorrhagic shock, the other one died of spontaneous peritonitis and septic shock. For general curative effect, 2 cases (6.7%) were healed, 22 cases (73.3%) were improved, and 6 cases were unhealed (20.0%, 4 cases occurred rebleeding, 2 cases died); 17 cases underwent CT portal venograpy, abnormal embolization was not found in any patients, glue extrusion bleeding occurred in 1 case (3.3%), no patients had severe postoperative complications. Conclusion Endoscopic clipping with histoacryl can be used in the prevention and treatment of type 2 gastroesophageal varices to improve the treatment effect and reduce postoperative bleeding risk, may have good clinical practice value.