Mostafa I, Omar M M, Nouh A
Division of Clinical Tropical Medicine, Theodor Bilharz Research Institute, Giza, Egypt.
J Egypt Soc Parasitol. 1997 Aug;27(2):405-10.
This trial represents the Egyptian experience in cyanoacrylate injection for hemostasis of bleeding gastric varices. One hundred patients with portal hypertension due to schistosomal hepatic fibrosis and/or posthepatitic liver cirrhosis were included. All patients presented with bleeding from gastric varices either fundal (80 patients) or inferior extension of esophageal varices (20 patients) were enrolled. Injection therapy was administered as the first active measure. No tamponade or drugs were used. Cyanoacrylate was mixed with lipid and injected through a hand-made probe. A mean of 3 (range 1-9) ampoules of cyanoacrylate were used per injection session. Bleeding stopped at the end of all sessions. Ten patients (12.5%) with fundal varices had rebleeding during the first 24 hours. Reinjection could control bleeding in 6 patients with a total success rate of 95%. Four patients were managed surgically. Fatal pulmonary embolism developed in one patient (1.25%) with fundal varix. Five more patients (6.25%) died from bleeding-related liver failure. In conclusion, injection of cyanoacrylate is highly satisfactory in controlling bleeding from both types of gastric varices.
本试验展示了埃及在使用氰基丙烯酸酯注射治疗胃静脉曲张出血方面的经验。纳入了100例因血吸虫性肝纤维化和/或肝炎后肝硬化导致门静脉高压的患者。所有患者均因胃静脉曲张出血而就诊，其中胃底部静脉曲张出血80例，食管静脉曲张向下延伸至胃出血20例。注射治疗作为首要积极措施进行。未使用压迫止血或药物。将氰基丙烯酸酯与脂质混合，通过自制探头进行注射。每次注射平均使用3支（范围1 - 9支）氰基丙烯酸酯安瓿。所有注射疗程结束时出血均停止。10例胃底部静脉曲张患者（12.5%）在最初24小时内再次出血。再次注射可控制6例患者的出血，总成功率为95%。4例患者接受了手术治疗。1例胃底部静脉曲张患者（1.25%）发生致命性肺栓塞。另外5例患者（6.25%）死于与出血相关的肝衰竭。总之，注射氰基丙烯酸酯在控制两种类型胃静脉曲张出血方面非常令人满意。
