标准化注射技术和方案可确保用于治疗胃底静脉曲张的N-丁基-2-氰基丙烯酸酯注射的成功与安全（附视频）。

A standardized injection technique and regimen ensures success and safety of N-butyl-2-cyanoacrylate injection for the treatment of gastric fundal varices (with videos).

作者信息

Seewald Stefan, Ang Tiing Leong, Imazu Hiroo, Naga Mazen, Omar Salem, Groth Stefan, Seitz Uwe, Zhong Yan, Thonke Frank, Soehendra Nib

机构信息

Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

Gastrointest Endosc. 2008 Sep;68(3):447-54. doi: 10.1016/j.gie.2008.02.050.

DOI:10.1016/j.gie.2008.02.050

PMID:18760173

Abstract

BACKGROUND

N-butyl-2-cyanoacrylate has been successfully used for the treatment of bleeding from gastric fundal varices (FV). However, significant rebleeding rates and serious complications including embolism have been reported.

OBJECTIVE

Our purpose was to analyze the safety and efficacy of N-butyl-2-cyanoacrylate for FV bleeding by using a standardized injection technique and regimen.

DESIGN

Retrospective.

SETTING

Two tertiary referral centers.

PATIENTS

A total of 131 patients (91 men/40 women) with FV underwent obliteration with N-butyl-2-cyanoacrylate by a standardized technique and regimen.

INTERVENTIONS

(1) Dilution of 0.5 mL of N-butyl-2-cyanoacrylate with 0.8 mL of Lipiodol, (2) limiting the volume of mixture to 1.0 mL per injection to minimize the risk of embolism, (3) repeating intravariceal injections of 1.0 mL each until hemostasis was achieved, (4) obliteration of all tributaries of the FV, (5) repeat endoscopy 4 days after the initial treatment to confirm complete obliteration of all visible varices and repeat N-butyl-2-cyanoacrylate injection if necessary to accomplish complete obliteration.

MAIN OUTCOME MEASUREMENTS

Immediate hemostasis rate, early rebleeding rate, bleeding-related mortality rate, procedure-related complications, long-term cumulative rebleeding-free rate, and cumulative survival rate.

RESULTS

Initial hemostasis and variceal obliteration were achieved in all patients. The mean number of sessions was 1 (range 1-3). The mean total volume of glue mixture used was 4.0 mL (range 1-13 mL). There was no occurrence of early FV rebleeding, procedure-related complications, or bleeding-related death. The cumulative rebleeding-free rate at 1, 3, and 5 years was 94.5%, 89.3%, and 82.9%, respectively.

CONCLUSION

Obliteration of bleeding FV with N-butyl-2-cyanoacrylate is safe and effective with use of a standardized injection technique and regimen.

摘要

背景

正丁基-2-氰基丙烯酸酯已成功用于治疗胃底静脉曲张（FV）出血。然而，有报道称其再出血率较高，且存在包括栓塞在内的严重并发症。

目的

我们的目的是通过使用标准化注射技术和方案来分析正丁基-2-氰基丙烯酸酯治疗FV出血的安全性和有效性。

设计

回顾性研究。

地点

两家三级转诊中心。

患者

共有131例FV患者（91例男性/40例女性）通过标准化技术和方案接受了正丁基-2-氰基丙烯酸酯闭塞治疗。

干预措施

（1）用0.8 mL碘油稀释0.5 mL正丁基-2-氰基丙烯酸酯；（2）每次注射将混合物体积限制在1.0 mL以内，以尽量降低栓塞风险；（3）重复进行每次1.0 mL的曲张静脉内注射，直至止血；（4）闭塞FV的所有分支；（5）初始治疗4天后复查内镜，确认所有可见静脉曲张完全闭塞，必要时重复注射正丁基-2-氰基丙烯酸酯以实现完全闭塞。