Trudeau W, Prindiville T
Gastrointest Endosc. 1986 Aug;32(4):264-8. doi: 10.1016/s0016-5107(86)71843-9.
Ninety-two consecutive, nonrandomized patients with bleeding varices were prospectively studied using sclerotherapy to control and prevent rebleeding. During this study, nine patients with gastric variceal bleeding were identified. A gastric variceal subset is defined and represents a 10% incidence in this series. All patients presented with indexed gastric bleeding varices that subsequently accounted for 34 bleeding sessions. The units of blood per rebleeding episode, hospital days, cost, and outcome were markedly different from the esophageal variceal groups. Initial management of indexed bleeding episodes by sclerotherapy and Sengstaken-Blakemore tubes were comparable; however, the number of rebleeding episodes was much higher. There was poor control of rebleeding with an associated higher rebleeding mortality and complications secondary to repeated sclerotherapy and Sengstaken-Blakemore tube use. In 37% of the patients, rebleeding was the direct result of gastric ulcerations at the endoscopic injection sclerotherapy site. The survival curve of this group was much lower than esophageal variceal bleeders. Endoscopic injection sclerotherapy in patients with bleeding gastric varices offers only temporary control of bleeding, and the high incidence of severe early rebleeding requires consideration of alternative methods for management or modified sclerotherapy techniques.
对92例连续性、非随机分组的静脉曲张出血患者进行前瞻性研究，采用硬化疗法控制和预防再出血。在本研究中，识别出9例胃静脉曲张出血患者。定义了一个胃静脉曲张亚组，在该系列中发生率为10%。所有患者均出现索引性胃出血性静脉曲张，随后发生了34次出血事件。每次再出血事件的输血量、住院天数、费用和结局与食管静脉曲张组明显不同。通过硬化疗法和Sengstaken-Blakemore管对索引性出血事件进行初始处理具有可比性；然而，再出血事件的数量要高得多。再出血控制不佳，伴有较高的再出血死亡率以及因反复使用硬化疗法和Sengstaken-Blakemore管导致的并发症。在37%的患者中，再出血是内镜注射硬化疗法部位胃溃疡的直接结果。该组的生存曲线远低于食管静脉曲张出血患者。内镜注射硬化疗法对胃静脉曲张出血患者仅能提供暂时的出血控制，且早期严重再出血的高发生率需要考虑替代的管理方法或改良的硬化疗法技术。
