Mitsunaga Tetsuya, Yoshida Hideo, Kouchi Katsunori, Hishiki Tomoro, Saito Takeshi, Yamada Shin-ichi, Sato Yoshiharu, Terui Keita, Nakata Mitsuyuki, Takenouchi Ayako, Ohnuma Naomi
Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
J Pediatr Surg. 2006 Dec;41(12):1980-3. doi: 10.1016/j.jpedsurg.2006.08.022.
BACKGROUND/PURPOSE: There are various treatment strategies for gastroesophageal varices in children. We studied the therapeutic value of endoscopic variceal clipping (EVC) and ligation (EVL).
Four hundred ninety-nine endoscopic examinations performed between 1991 and 2005 were retrospectively analyzed. F2 and F3 varices with red color signs on follow-up endoscopy were treated with prophylactic EVC. In variceal rupture cases, EVC and EVL were used in combination.
Eighty-two prophylactic EVCs were done, and variceal progression was prevented in 89.9%. However, some patients had persistent red color signs and required frequent EVC. Ten emergent procedures were done for variceal rupture, and, in 4 cases, EVL was used to arrest massive variceal bleeding. Five patients developed bleeding during follow-up cause by rupture of gastric fundal varices, which probably had been aggravated by prior treatment for esophageal varices.
The control of gastroesophageal varices by routine EVC was satisfactory. However, ruptures during follow-up suggested the importance of controlling gastric fundal varices. Endoscopic variceal ligation is a simple, effective, and safe treatment tool, particularly for ruptured varices. However, it is difficult to treat gastric fundal varices with EVL; this disadvantage of EVL can be overcome by the concomitant use of EVC.
背景/目的：儿童胃食管静脉曲张有多种治疗策略。我们研究了内镜下静脉曲张套扎术（EVC）和结扎术（EVL）的治疗价值。
回顾性分析1991年至2005年间进行的499例内镜检查。随访内镜检查发现有红色征的F2和F3级静脉曲张采用预防性EVC治疗。对于静脉曲张破裂病例，联合使用EVC和EVL。
共进行了82例预防性EVC，89.9%的病例预防了静脉曲张进展。然而，一些患者仍有持续性红色征，需要频繁进行EVC。对10例静脉曲张破裂进行了急诊手术，其中4例使用EVL控制大量静脉曲张出血。5例患者在随访期间因胃底静脉曲张破裂出血，这可能是由于先前对食管静脉曲张的治疗而加重。
常规EVC对胃食管静脉曲张的控制效果满意。然而，随访期间的破裂提示控制胃底静脉曲张的重要性。内镜下静脉曲张结扎术是一种简单、有效且安全的治疗工具，尤其适用于破裂的静脉曲张。然而，用EVL治疗胃底静脉曲张困难；EVC的联合使用可克服EVL的这一缺点。
Zotero 插件