内镜下Histoacryl（N-丁基-2-氰基丙烯酸酯）注射治疗胃静脉曲张的长期结果。
Long-term result of endoscopic Histoacryl (N-butyl-2-cyanoacrylate) injection for treatment of gastric varices.
机构信息
Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul 140-743, South Korea.
出版信息
World J Gastroenterol. 2011 Mar 21;17(11):1494-500. doi: 10.3748/wjg.v17.i11.1494.
AIM
To evaluate the long-term efficacy and safety of endoscopic obliteration with Histoacryl(®) for treatment of gastric variceal bleeding and prophylaxis.
METHODS
Between January 1994 and March 2010 at SoonChunHyang University Hospital, a total of 127 patients with gastric varices received Histoacryl(®) injections endoscopically. One hundred patients underwent endoscopic Histoacryl(®) injections because of variceal bleeding, the other 27 patients received such injections as a prophylactic procedure.
RESULTS
According to Sarin classification, 56 patients were GOV1, 61 patients were GOV2 and 10 patients were IGV. Most of the varices were large (F2 or F3, 111 patients). The average volume of Histoacryl(®) per each session was 1.7 ± 1.3 cc and mean number of sessions was 1.3 ± 0.6. (1 session-98 patients, 2 sessions-25 patients, ≥ 3 sessions-4 patients). Twenty-seven patients with high risk of bleeding (large or fundal or RCS+ or Child C) received Histoacryl(®) injection as a primary prophylactic procedure. In these patients, hepatitis B virus was the major etiology of cirrhosis, 25 patients showed GOV1 or 2 (92.6%) and F2 or F3 accounted for 88.9% (n = 24). The rate of initial hemostasis was 98.4% and recurrent bleeding within one year occurred in 18.1% of patients. Successful hemostasis during episodes of rebleeding was achieved in 73.9% of cases. Median survival was 50 mo (95% CI 30.5-69.5). Major complications occurred in 4 patients (3.1%). The rebleeding rate in patients with hepatocellular carcinoma or GOV2 was higher than in those with other conditions. None of the 27 subjects who were treated prophylactically experienced treatment-related complications. Cumulative survival rates of the 127 patients at 6 mo, 1, 3, and 5 years were 92.1%, 84.2%, 64.2%, and 45.3%, respectively. The 6 mo cumulative survival rate of the 27 patients treated prophylactically was 75%.
CONCLUSION
Histoacryl(®) injection therapy is an effective treatment for gastric varices and also an effective prophylactic treatment of gastric varices which carry high risk of bleeding.
目的
评估Histoacryl（®）内镜下闭塞治疗胃静脉曲张出血和预防的长期疗效和安全性。
方法
1994 年 1 月至 2010 年 3 月，我院共对 127 例胃静脉曲张患者进行了Histoacryl（®）注射内镜治疗。100 例患者因静脉曲张出血而行内镜Histoacryl（®）注射治疗，27 例患者作为预防性治疗。
结果
根据 Sarin 分类，56 例为 GOV1，61 例为 GOV2，10 例为 IGV。大多数静脉曲张为大（F2 或 F3，111 例）。每次注射Histoacryl（®）的平均体积为 1.7±1.3cc，平均注射次数为 1.3±0.6 次。（1 次注射 98 例，2 次注射 25 例，≥3 次注射 4 例）。27 例高危出血（大、胃底或 RCS+或 Child C）患者接受Histoacryl（®）注射作为一级预防性治疗。在这些患者中，乙型肝炎病毒是肝硬化的主要病因，25 例为 GOV1 或 2（92.6%），F2 或 F3 占 88.9%（n=24）。初始止血率为 98.4%，1 年内再出血率为 18.1%。73.9%的病例再出血时成功止血。中位生存时间为 50 个月（95%CI 30.5-69.5）。4 例（3.1%）发生严重并发症。肝细胞癌或 GOV2 患者的再出血率高于其他患者。27 例预防性治疗患者均未发生与治疗相关的并发症。127 例患者的 6 个月、1 年、3 年和 5 年累积生存率分别为 92.1%、84.2%、64.2%和 45.3%。27 例预防性治疗患者的 6 个月累积生存率为 75%。
结论
Histoacryl（®）注射治疗是治疗胃静脉曲张的有效方法，也是治疗高出血风险胃静脉曲张的有效预防方法。
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