内镜下注射丁基-2-氰基丙烯酸酯治疗胃静脉曲张出血后胶体外溢的研究。
Study of glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding.
机构信息
Department of Gastroenterology, the Second Affiliated Hospital of PLA General Hospital, No. 17 at Heishanhu Road, Haidian Region, Beijing 100091, China.
出版信息
World J Gastroenterol. 2009 Oct 21;15(39):4945-51. doi: 10.3748/wjg.15.4945.
AIM
To investigate glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding and to evaluate the long-term efficacy and safety of this therapy.
METHODS
A total of 148 cirrhotic patients in our hospital with esophagogastric variceal bleeding (EGVB) were included in this study. N-butyl-2-cyanoacrylate was mixed with lipiodol in a 1:1 ratio and injected as a bolus of 1-3 mL according to variceal size. Patients underwent endoscopic follow-up the next week, fourth week, second month, fourth month, and seventh month after injection and then every 6 mo to determine the cast shape. An abdominal X-ray film and ultrasound or computed tomographic scan were also carried out in order to evaluate the time of variceal disappearance and complete extrusion of the cast. The average follow-up time was 13.1 mo.
RESULTS
The instantaneous hemostatic rate was 96.2%. Early re-bleeding after injection in 9 cases (6.2%) was estimated from rejection of adhesive. Late re-bleeding occurred in 12 patients (8.1%) at 2-18 mo. The glue cast was extruded into the lumen within one month in 86.1% of patients and eliminated within one year. Light erosion was seen at the injection position and mucosa edema in the second week. The glue casts were extruded in 18 patients (12.1%) after one week and in 64 patients (42.8%) after two weeks. All kinds of glue clumping shapes and colors on endoscopic examination were observed in 127 patients (86.1%) within one month, including punctiform, globular, pillar and variform. Forty one patients (27.9%) had glue extrusion after 3 mo and 28 patients (28.9%) after six months. The extrusion time was not related to the injection volume of histoacryl. Obliteration was seen in 70.2% (104 cases) endoscopically. The main complication was re-bleeding resulting from extrusion. The prognosis of the patients depended on the severity of the underlying liver disease.
CONCLUSION
Endoscopic injection of cyanoacrylate is highly effective for gastric varices bleeding. The glue clump shape is correlated with anatomic structure of vessels. The time of extrusion was not related to dosage of the glue.
目的
研究内镜下注射氰基丙烯酸丁酯后胃静脉曲张出血的胶溢出情况，并评价该治疗的长期疗效和安全性。
方法
本研究共纳入我院 148 例肝硬化合并食管胃静脉曲张出血（EGVB）患者。将氰基丙烯酸丁酯与碘油按 1:1 的比例混合，根据静脉大小以 1-3 mL 的剂量推注。患者在注射后第 1 周、第 4 周、第 2 个月、第 4 个月和第 7 个月进行内镜随访，并在之后每 6 个月进行一次，以确定铸型的形状。同时进行腹部 X 线片、超声或 CT 扫描，以评估静脉消失和铸型完全排出的时间。平均随访时间为 13.1 个月。
结果
即刻止血率为 96.2%。9 例（6.2%）患者因排斥性黏附而出现注射后早期再出血。12 例（8.1%）患者在 2-18 个月后出现迟发性再出血。86.1%的患者在 1 个月内胶铸型排入管腔并在 1 年内排出。第 2 周时可见注射部位黏膜轻度侵蚀和水肿。1 周后 18 例（12.1%）、2 周后 64 例（42.8%）患者胶铸型排出。127 例（86.1%）患者在 1 个月内内镜检查可见各种胶凝结形状和颜色，包括点状、球形、柱状和变形。41 例（27.9%）患者在 3 个月后和 28 例（28.9%）患者在 6 个月后出现胶溢出。胶铸型排出时间与组织胶的注射量无关。70.2%（104 例）患者内镜下可见静脉闭塞。主要并发症为胶溢出导致的再出血。患者的预后取决于基础肝病的严重程度。
结论
内镜下注射氰基丙烯酸酯治疗胃静脉曲张出血效果显著。胶凝结形状与血管解剖结构有关。胶铸型排出时间与胶剂量无关。
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