CAJ | 학술논문

背景：作为国内临床常用的组织黏合剂，组织胶可瞬间产生聚合反应，具有生物组织固化速度快的优点，治疗食管胃底静脉曲张破裂出血具有很好的效果。目的：探讨内镜下组织胶注射联合套扎法治疗重度食管胃底静脉曲张的近、远期临床疗效。方法：纳入90例重度食管静脉曲张合并胃底静脉曲张患者，其中男64例，女26例，年龄22-75岁，在内镜下采用组织胶注射治疗胃静脉曲张，联合食管静脉曲张套扎治疗食管静脉曲张。治疗后2-4周内复查内镜，观察止血率、静脉曲张、曲张静脉直径、红色征、门静脉高压胃病情况等近期疗效和不良反应；曲张静脉消除后随访3-39个月，观察静脉曲张情况、组织胶排胶情况和局部增生状况、再出血、复发等中远期临床疗效及并发症。结果与结论：①近期疗效：与治疗前比较，治疗后患者曲张静脉数目明显减少、红色征发生率降低、静脉高压性胃病好转(P均<0.01)，但3例发生早期再出血。组织胶在治疗2周-3个月开始排出，未发生与组织胶注射治疗直接有关的食管狭窄、穿孔、严重感染、异位栓塞等并发症。②中远期疗效：静脉曲张复发9例，5例发生远期再出血。表明经内镜注射组织胶联合密集套扎法治疗重度食管胃底静脉曲张或(和)出血疗效确切，操作成功率高，止血效果好，并能有效预防远期再次出血，复发率低。
배경：작위국내림상상용적조직점합제，조직효가순간산생취합반응，구유생물조직고화속도쾌적우점，치료식관위저정맥곡장파렬출혈구유흔호적효과。목적：탐토내경하조직효주사연합투찰법치료중도식관위저정맥곡장적근、원기림상료효。방법：납입90례중도식관정맥곡장합병위저정맥곡장환자，기중남64례，녀26례，년령22-75세，재내경하채용조직효주사치료위정맥곡장，연합식관정맥곡장투찰치료식관정맥곡장。치료후2-4주내복사내경，관찰지혈솔、정맥곡장、곡장정맥직경、홍색정、문정맥고압위병정황등근기료효화불량반응；곡장정맥소제후수방3-39개월，관찰정맥곡장정황、조직효배효정황화국부증생상황、재출혈、복발등중원기림상료효급병발증。결과여결론：①근기료효：여치료전비교，치료후환자곡장정맥수목명현감소、홍색정발생솔강저、정맥고압성위병호전(P균<0.01)，단3례발생조기재출혈。조직효재치료2주-3개월개시배출，미발생여조직효주사치료직접유관적식관협착、천공、엄중감염、이위전새등병발증。②중원기료효：정맥곡장복발9례，5례발생원기재출혈。표명경내경주사조직효연합밀집투찰법치료중도식관위저정맥곡장혹(화)출혈료효학절，조작성공솔고，지혈효과호，병능유효예방원기재차출혈，복발솔저。
BACKGROUND:As a commonly used tissue adhesive in China, histoacryl can produce transient polymerization and rapidly solidify biological tissue, and it has good prospect in treatment of esophageal and gastric varicose bleeding. OBJECTIVE: To explore the short- and long-term clinical efficacy of endoscopic histoacryl injection combined with ligation for the treatment of esophageal and gastric varices. METHODS: Ninety patients with esophageal and gastric varices were treated by endoscopic adhesive injection and dense ligation. There were 64 males and 26 females, aged 22-75 years. At 2-4 weeks post-treatment, patients were re-checked under an endoscope. The short-term efficacy and adverse reactions, such as the hemostasis rate, varicose vein, varicose vein diameter, red color sign and portal hypertension gastropathy were observed. Al patients were folowed up for 3-39 months after varicose vein was eradicated, to monitor the middle- and long-term clinical efficacy, including varicose vein, tissue adhesive discharging and local proliferation, rebleeding, recurrence and complications. RESULTS AND CONCLUSION: (1) Short-term efficacy: The number of varicose veins significantly reduced, red color signs reduced, and portal hypertension gastropathy improved (P< 0.01), but three cases appeared early rebleeding. The adhesives began to discharge from 2 weeks to 3 months post-treatment, no case appeared esophageal stenosis, perforation, severe infection, heterotopic embolism and other injection-related complication. (2) Middle- and long-term efficacy: varicose vein recurred in nine cases and five cases developed long-term rebleeding. Experimental findings indicate that, endoscopic histoacryl injection combined with ligation is effective to treat severe esophageal varices or (and) bleeding, with high success rate and good hemostasis effect, and it also prevents long-term rebleeding and recurrence.