Oh Seak Hee, Kim Seung Jin, Rhee Kang Won, Kim Kyung Mo
Seak Hee Oh, Seung Jin Kim, Kang Won Rhee, Kyung Mo Kim, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 138-736, South Korea.
World J Gastroenterol. 2015 Mar 7;21(9):2719-24. doi: 10.3748/wjg.v21.i9.2719.
To evaluate the efficacy and safety of N-butyl-2-cyanoacrylate in treating acute bleeding of gastric varices in children.
The retrospective study included 21 children with 47 episodes of active gastric variceal bleeding who were treated by endoscopic injection of N-butyl-2-cyanoacrylate at Asan Medical Center Children's Hospital between August 2004 and December 2011. To reduce the risk of embolism, each injection consisted of 0.1-0.5 mL of 0.5 mL N-butyl-2-cyanoacrylate diluted with 0.5 or 0.8 mL Lipiodol. The primary outcome was incidence of hemostasis after variceal obliteration and the secondary outcome was complication of the procedure.
The 21 patients experienced 47 episodes of active gastric variceal bleeding, including rebleeding, for which they received a total of 52 cyanoacrylate injections. Following 42 bleeding episodes, hemostasis was achieved after one injection and following five bleeding episodes it was achieved after two injections. The mean volume of each single aliquot of cyanoacrylate injected was 0.3 ± 0.1 mL (range: 0.1-0.5 mL). Injection achieved hemostasis in 45 of 47 (95.7%) episodes of acute gastric variceal bleeding. Eleven patients (52.4%) developed rebleeding events, with the mean duration of hemostasis being 11.1 ± 11.6 mo (range: 1.0-39.2 mo). No treatment-related complications such as distal embolism were noted with the exception of abdominal pain in one patient (4.8%). Among four mortalities, one patient died of variceal rebleeding.
Endoscopic variceal obliteration using a small volume of aliquots with repeated cyanoacrylate injection was an effective and safe option for the treatment of gastric varices in children.
评估N-丁基-2-氰基丙烯酸酯治疗儿童胃静脉曲张急性出血的疗效和安全性。
这项回顾性研究纳入了2004年8月至2011年12月在峨山医学中心儿童医院接受内镜下注射N-丁基-2-氰基丙烯酸酯治疗的21例儿童，共发生47次活动性胃静脉曲张出血。为降低栓塞风险，每次注射由0.1 - 0.5 mL的0.5 mL N-丁基-2-氰基丙烯酸酯用0.5或0.8 mL碘油稀释而成。主要结局是静脉曲张闭塞后止血的发生率，次要结局是手术并发症。
21例患者共发生47次活动性胃静脉曲张出血，包括再出血，共接受了52次氰基丙烯酸酯注射。42次出血事件经一次注射后止血，5次出血事件经两次注射后止血。每次注射的氰基丙烯酸酯单剂量平均体积为0.3±0.1 mL（范围：0.1 - 0.5 mL）。47次急性胃静脉曲张出血事件中有45次（95.7%）注射后实现止血。11例患者（52.4%）发生再出血事件，止血的平均持续时间为11.1±11.6个月（范围：1.0 - 39.2个月）。除1例患者（4.8%）出现腹痛外，未观察到与治疗相关的并发症，如远端栓塞。4例死亡患者中，1例死于静脉曲张再出血。
使用小剂量分次重复注射氰基丙烯酸酯进行内镜下静脉曲张闭塞术是治疗儿童胃静脉曲张的一种有效且安全的选择。
