This report describes a 52-year-old male patient with blunt abdominal traumatic rupture of the spleen due to injuries sustained in an automobile accident. Following splenectomy, the patient developed a gastric fistula...This report describes a 52-year-old male patient with blunt abdominal traumatic rupture of the spleen due to injuries sustained in an automobile accident. Following splenectomy, the patient developed a gastric fistula. He underwent a long period of conservative treatment, including antibiotics and total parenteral nutrition, which was ineffective. The fistula could not be closed and titanium clip closure using a gastroscopy was then performed in order to close the fistula. After endoscopic therapy and clipping surgery, the patient's general condition improved significantly, and he had no post-procedural abdominal complications. On postclipping day 6, the gastric fistula was completely closed as shown by X-ray examination of the upper digestive tract. The patient was discharged from hospital and no complications were observed during the six-month follow-up period. Our report suggests that titanium clip closure using endoscopy may be the choice of treatment in patients with a gastric fistula.展开更多
目的采用网状Meta分析比较球囊阻塞逆行经静脉闭塞术(BRTO)、超声内镜(EUS)引导线圈栓塞联合内镜下组织胶注射以及钛夹辅助组织胶注射(CLIP-ECI)治疗胃静脉曲张的安全性和有效性。方法检索PubMed、Web of Science、Cochrane Library、Em...目的采用网状Meta分析比较球囊阻塞逆行经静脉闭塞术(BRTO)、超声内镜(EUS)引导线圈栓塞联合内镜下组织胶注射以及钛夹辅助组织胶注射(CLIP-ECI)治疗胃静脉曲张的安全性和有效性。方法检索PubMed、Web of Science、Cochrane Library、EmBase、中国知网、万方医学网,中国生物医学数据库自建库至2024年7月1日所有涉及“球囊阻塞逆行经静脉闭塞术”“超声内镜引导线圈栓塞联合内镜下组织胶注射”“钛夹辅助组织胶注射”的随机对照研究、回顾性研究,依据纳入及排除标准筛选文献,使用随机效应模型处理数据,采用STATA14.0软件进行网状Meta分析。结果共纳入22篇文献(其中RCT研究7篇,回顾性研究15篇),总样本量为2122例患者。网状Meta分析结果显示:在预防再出血方面,BRTO组[累积排名曲线下的面积(surface under the cumulative ranking curve,SUCRA)93.5]再出血率最低,其次为EUS组(SUCRA 72.0);在死亡率方面,CLIP-ECI组(SUCRA 82.1)总死亡率最低,其次为BRTO组(SUCRA 75.5);在异位栓塞率方面,BRTO组(SUCRA 68.7)发生异位栓塞可能性最小,ECI组(SUCRA 23.8)发生异位栓塞可能性最大;在胃静脉曲张消除方面,BRTO组(SUCRA 95.4)静脉曲张消除率最高,其次为EUS组(SUCRA 60.7)。结论与内镜治疗相比,BRTO可降低胃静脉曲张再出血率,提高消除率,且异位栓塞率和死亡率更低,是有效安全的治疗手段。展开更多
基金Supported by the Program of Central Financial Support for Local Universities of China,No.SCKBMI-13-004the Project of Sichuan Provincial Health Bureau of China,No.130334
文摘This report describes a 52-year-old male patient with blunt abdominal traumatic rupture of the spleen due to injuries sustained in an automobile accident. Following splenectomy, the patient developed a gastric fistula. He underwent a long period of conservative treatment, including antibiotics and total parenteral nutrition, which was ineffective. The fistula could not be closed and titanium clip closure using a gastroscopy was then performed in order to close the fistula. After endoscopic therapy and clipping surgery, the patient's general condition improved significantly, and he had no post-procedural abdominal complications. On postclipping day 6, the gastric fistula was completely closed as shown by X-ray examination of the upper digestive tract. The patient was discharged from hospital and no complications were observed during the six-month follow-up period. Our report suggests that titanium clip closure using endoscopy may be the choice of treatment in patients with a gastric fistula.
