设为首页 | 加入收藏
| 欢迎光临本站!

消化内镜学分会官方网站

当前位置:文献追踪 > 国内外期刊

经食道超声内镜引导下与结合弹簧圈和氰基丙烯酸酯胶注射治疗胃底静脉曲张

发布日期:2014-1-29 12:40:22 文章来源:GIE 作者次数:1280
    经食道超声内镜引导下与结合弹簧圈和氰基丙烯酸酯胶注射治疗胃底静脉曲张
     
    背景
    目前已有很多关于内镜下氰基丙烯酸酯(CYA)胶治疗胃底静脉曲张(GFV)后发生胶栓塞的相关的报道,对某些病例来说这是致命的。附有合成纤维的线圈可能减少或消除这种风险,而且还可能会降低达到闭塞所需的氰基丙烯酸酯量。
     
    目的
    评估经食管超声内镜引导下用弹簧圈和氰基丙烯酸酯注射联合治疗胃底静脉曲张的可行性,安全性和成效性。
     
    设计
    回顾性查询前瞻性维护的数据库查询。
     
    背景
    三级保健医疗中心。
     
    患者
    胃底静脉曲张大出血患者。
     
    干预
    利用超声内镜引导的弹簧圈和氰基丙烯酸酯治疗的标准化方法。
     
    主要结果测量
    止血,再出血发生率,并发症。
     
    结果
    2009年3月和2011年1月间共收治30例胃底静脉曲张患者。在指数胃镜检查中,2例患者有活动性出血,14例有最近出血痕迹。超声内镜引导下经食管成功治疗所有胃底静脉曲张患者。所治疗的胃底静脉曲张平均数是1.3/例,每静脉曲张平均注射1.4ml 2-辛基-氰基丙烯酸酯。急性出血止血率为100%。其中24例患者平均随访193天(范围:24-589天),一个疗程后23例胃底静脉曲张消失(96%)。4例发生非胃底静脉曲张引起的再出血(16.6%)。没有与此手术相关的并发症且无任何氰基丙烯酸酯栓塞症状或体征。
     
    局限性:
    单中心初步研究。
     
    结论
    经食管超声内镜引导下的弹簧圈和氰基丙烯酸酯治疗胃底静脉曲张是可行的,并值得进一步的研究,以确定这种新方法是否可以提高其安全性和有效性,并超过标准内镜下单独注射氰基丙烯酸酯。
     

    缩写词:CY A,氰基丙烯酸酯;FV-CLA,向前查看弯曲线性阵列;GFV,胃底静脉曲张。

     

    EUS-guided transesophageal treatment of gastric fundal varices with combined coiling and cyanoacrylate glue injection
    Background
    There have been numerous reports of glue embolization after endoscopic cyanoacrylate (CYA) glue treatment of gastric fundal varices (GFV), with some cases fatal. Coils with attached synthetic fibers may decrease or eliminate this risk and may decrease the amount of CYA needed to achieve obliteration.
    Objective
    Assess the feasibility, safety, and outcomes of transesophageal EUS-guided therapy of GFV with combined coil and CYA injection.
    Design
    Retrospective query of a prospectively maintained database.
    Setting
    Tertiary care medical center.
    Patients
    Patients with hemorrhage from large GFV.
    Intervention
    A standardized approach by using EUS-guided coil and CYA treatment.
    Main Outcomes Measurements
    Hemostasis, rebleeding rate, complications.
    Results
    Thirty patients with GFV were treated between March 2009 and January 2011. At index endoscopy, 2 patients had active hemorrhage and 14 had stigmata of recent hemorrhage. EUS-guided transesophageal treatment of GFV was successful in all. Mean number of GFV treated was 1.3 per patient, and the mean volume of 2-octyl-CYA injected was 1.4 mL per varix. Hemostasis of acute bleeding was 100%. Among 24 patients with a mean follow-up of 193 days (range 24-589 days), GFV were obliterated after a single treatment session in 23 (96%). Rebleeding occurred in 4 patients (16.6%), with none attributed to GFV. There were no procedure-related complications and no symptoms or signs of CYA embolization.
    Limitations
    Single-center, pilot study.
    Conclusion
    Transesophageal EUS-guided coil and CYA treatment of GFV is feasible and deserves further study to determine whether this novel approach can improve safety and efficacy over standard endoscopic injection of CYA alone.
    (作者:)
相关评论
用户名: 登录