Sung J J, Yeo W, Suen R, Lee Y T, Chung S C, Chan F K, Johnson P J
Department of Medicine, The Chinese University of Hong Kong.
Gastrointest Endosc. 1998 Mar;47(3):235-9. doi: 10.1016/s0016-5107(98)70319-0.
Patients with hepatocellular carcinoma complicated by variceal bleeding have a very limited life span. Recurrent bleeding after endoscopic injection sclerotherapy is common. Our aim was to compare the efficacy of endoscopic injection of cyanoacrylate versus sodium tetradecyl sulphate in the control of variceal bleeding in patients with hepatocellular carcinoma.
Patients known to be suffering from inoperable hepatocellular carcinoma who presented with upper gastrointestinal bleeding underwent endoscopy within 24 hours of admission. After bleeding from esophageal varices was confirmed, they were randomized to receive endoscopic injections of either cyanoacrylate (1:1 mixture with Lipoidol) or sodium tetradecyl sulphate (1.5%). Injection were given intravariceally into each visible column for up to four injections for cyanoacrylate and up to 30 mL for sodium tetradecyl sulphate.
A total of 50 patients were recruited for this study with 25 cases randomized to each endoscopic treatment group. Control of acute bleeding failed in four patients (16%) in both treatment groups, and two patients in each group died during the index episode of bleeding. Six patients (24%) in the cyanoacrylate group and four patients (16%) in the sodium tetradecyl sulphate group developed recurrent bleeding during their hospital stay (p = 0.48). Recurrent bleeding within 30 days after the index episode of bleeding was documented in seven patients (28%) who received cyanoacrylate injection and five patients (20%) who received sodium tetradecyl sulphate injection (p = 0.51). Median survival in the cyanoacrylate group was 16 days (range 1 to 485 days) and that of the sodium tetradecyl sulphate group was 13 days (range 1 to 407 days). There was no difference in cumulative survival between the two groups as analyzed by the Kaplan-Meier method. Patients with portal vein thrombosis had a higher risk of recurrent hemorrhage. Patients with Child's C liver disease had a significantly higher mortality.
Cyanoacrylate did not improve the outcome of hepatocellular carcinoma patients with variceal hemorrhage.
肝细胞癌合并静脉曲张出血的患者寿命非常有限。内镜注射硬化治疗后复发出血很常见。我们的目的是比较内镜下注射氰基丙烯酸酯与十四烷基硫酸钠在控制肝细胞癌患者静脉曲张出血方面的疗效。
已知患有无法手术切除的肝细胞癌且出现上消化道出血的患者在入院后24小时内接受内镜检查。确认食管静脉曲张出血后，将他们随机分为接受内镜注射氰基丙烯酸酯（与碘油按1:1混合）或十四烷基硫酸钠（1.5%）的两组。向每个可见的静脉柱内曲张静脉注射，氰基丙烯酸酯最多注射4次，十四烷基硫酸钠最多注射30 mL。
本研究共招募了50名患者，每个内镜治疗组随机分配25例。两个治疗组均有4例患者（16%）急性出血控制失败，每组各有2例患者在出血指数发作期间死亡。氰基丙烯酸酯组有6例患者（24%）和十四烷基硫酸钠组有4例患者（16%）在住院期间出现复发出血（p = 0.48）。出血指数发作后30天内，接受氰基丙烯酸酯注射的7例患者（28%）和接受十四烷基硫酸钠注射的5例患者（20%）记录到复发出血（p = 0.51）。氰基丙烯酸酯组的中位生存期为16天（范围1至485天），十四烷基硫酸钠组为13天（范围1至407天）。采用Kaplan-Meier方法分析，两组的累积生存率无差异。门静脉血栓形成的患者复发出血风险更高。Child's C级肝病患者的死亡率显著更高。
氰基丙烯酸酯并不能改善肝细胞癌合并静脉曲张出血患者的预后。
