Ogawa K, Ishikawa S, Naritaka Y, Shimakawa T, Wagatsuma Y, Katsube A, Kajiwara T
Department of Surgery, Tokyo Women's Medical University Daini Hospital, Japan.
J Gastroenterol Hepatol. 1999 Mar;14(3):245-50. doi: 10.1046/j.1440-1746.1999.01842.x.
Emergency endoscopic injection sclerotherapy (EIS) has been applied to the initial treatment of gastric variceal bleeding and various methods have been attempted.
Emergency EIS was performed on 38 patients with gastric variceal bleeding using either the ethanolamine oleate (EO) method or n-butyl-2-cyanoacrylate (Histoacryl) method and the outcome was compared.
Complete haemostasis was defined as continuous haemostasis lasting for 14 days or more. Complete haemostasis was achieved in 52.4% of patients in the EO method versus 100% of those treated with the Histoacryl method, a significant difference, suggesting that the Histoacryl method was superior for achieving haemostasis in an emergency. The cumulative non-bleeding rate was also significantly higher in patients treated with Histoacryl, indicating the durability of haemostasis. There were no serious complications in patients who received either method of sclerotherapy. Post-EIS surgery was required in 42.8% of patients treated with EO, while no surgery was required in those treated with Histoacryl, supporting the greater haemostatic effect of Histoacryl. Although there was no significant difference in the cumulative survival rates of patients treated by these two methods, death from haemorrhage was avoided by using Histoacryl.
Based on these results, the Histoacryl method is thought to be the initial treatment of choice for gastric variceal bleeding, because it achieved superior haemostasis compared with EO and death by haemorrhage was avoided.
急诊内镜注射硬化疗法（EIS）已应用于胃静脉曲张出血的初始治疗，并尝试了多种方法。
对38例胃静脉曲张出血患者采用油酸乙醇胺（EO）法或氰基丙烯酸正丁酯（组织黏合剂）法进行急诊EIS，并比较结果。
完全止血定义为持续止血14天或更长时间。EO法患者的完全止血率为52.4%，而组织黏合剂法治疗的患者为100%，差异有统计学意义，表明组织黏合剂法在急诊止血方面更具优势。组织黏合剂治疗患者的累积无出血率也显著更高，表明止血的持久性。接受任何一种硬化疗法的患者均未出现严重并发症。EO法治疗的患者中有42.8%需要在EIS后进行手术，而组织黏合剂法治疗的患者无需手术，这支持了组织黏合剂具有更强的止血效果。虽然这两种方法治疗的患者累积生存率无显著差异，但使用组织黏合剂可避免因出血导致的死亡。
基于这些结果，组织黏合剂法被认为是胃静脉曲张出血的首选初始治疗方法，因为与EO法相比，它具有更好的止血效果且避免了因出血导致的死亡。
