摘要
目的 分析孤立性胃底静脉曲张的病因和治疗方法。方法 回顾分析我院 1987年 4月至 1999年 3月检查治疗 10 2 0例食管胃底静脉曲张病人 ,发现孤立性胃底静脉曲张 44例 ,占 4.31%。对 44例临床资料进行分析。结果 (1)病因 :肝硬化门脉高压 37例 ,其他 7例。 (2 )治疗结果 :硬化治疗 12例 ,急诊 9例。组织粘合剂注射 17例 ,急诊治疗 6例 ,硬化和组织粘合剂治疗全部止血 ,3～ 5 0天排胶再发出血 4例。经自发性胃肾分流道栓塞胃底静脉曲张 7例 ,手术治疗 5例 ,可脱性尼龙圈套扎胃底静脉 1例 ,6例未治疗。结论 (1)在我国孤立性胃底静脉曲张主要病因是病毒性肝炎肝硬化门脉高压所致。 (2 )能手术者应首选手术治疗 ;内镜下组织粘合剂注射和硬化治疗可用于急诊止血 ,但均复发出血率高 ;经自发性胃肾分流道闭塞胃底静脉曲张是安全可行的技术 ;可脱性尼龙圈套扎胃底静脉曲张操作困难。
Objective To analyze the etiology and therapeutic modalities of isolated gastric varices. Methods 44 patients (4.31%) were diagnosed as isolated gastric varices in 1 020 patients with esophageal and gastric varices during April 1987 to March 1999, and their clinical data were analyzed. Results 1. Etiology: cirrhosis and portal hypertension ( n =37), due to hepatitis B ( n =34), among them three were complicated with hepatocellular carcinoma. Other etiologies ( n =7) were as follows: one with chronic pancreatitis and hepatic vein occlusion syndrome, and one lymph node metastasis at the tail of pancreas secondary to renal carcinoma, another one with lymph node tuberculosis at the splenic hilum, one primary medullar sclerosis, etiology unknown in two. 2. Therapy: 12 patients were treated with sclerotherapy, 9 of which received emergency treatment. 17 cases were injected with tissue adhesives, of whom 6 received emergency treatment, bleeding ceased in all cases. Balloon occluded retrograde transvenous obliteration (B RTO) was performed via spontaneous gastric renal shunt in 7 cases, 6 were successful. Surgery was performed in 5 cases. Ligation with detachable snare was performed in 1 case. 6 cases were left untreated. Conclusions Surgery is the treatment of choice only for selective cases in accordance with underlying etiology. Injection with tissue adhesives and sclerosants can be used for emergency cases, but rebleeding is frequent. B RTO is safe and feasible whereas ligation with detachable snare is difficult to handle.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2000年第1期42-44,共3页
Chinese Journal of Digestion
