EUS引导弹簧圈联合组织粘合剂栓塞治疗合并自发分流道形成的胃底曲张静脉

EUS-guided Coiling Combined Histoacryl Injection in Patients with Spontaneous Portal-systemic Shunt and Gastric Varices

摘要:

食管胃底静脉曲张破裂出血是常见的消化系统急危重症之一。内镜治疗是食管胃底静脉曲张的有效治疗方案。自发性门体分流形成的患者组织粘合剂栓塞治疗发生异位栓塞的风险大。方法 经腹部CT门静脉血管重建确认自发性分流道形成，胃镜检查发现合并重度胃底静脉曲张的患者行EUS引导弹簧圈栓塞治疗。结果 共8例经腹部CT门静脉血管重建证实的自发性分流道形成的患者接受了EUS引导弹簧圈栓塞联合组织粘合剂栓塞治疗。4例活动性出血患者治疗后活动性出血均停止。观察至术后14天，全部8例患者（100%）均未有再出血及异位栓塞征象。 结论 EUS引导弹簧圈联合组织粘合剂栓塞治疗合并自发分流道形成的胃底曲张静脉患者安全有效。

Abstract:

Patients with esophageal and gastroesophageal varices bleeding are common?emergency?severe?cases. Endoscopic therapy methods are usually effective. Patients with spontaneous portal-systemic shunt have high risk of ectopic embolism after Histoacryl injection. Methods Patients with spontaneous portal-systemic shunt confirmed by CT portal venography, when severe gastric varices were found by EDG, EUS-guided coiling combined Histoacryl injection were performed. Results EUS-guided coiling and Histoacryl injection were performed in 8 patients with spontaneous portal-systemic shunt confirmed by CT portal venography. Active bleeding were effectively stopped in all (n=4) patients after the procedure. Signs of re-bleeding and ectopic embolism were NOT observed in all of the 8 patients up to 14 days after the procedure. Conclusion EUS-guided coiling combined Histoacryl injection in patients with spontaneous portal-systemic shunt and gastric varices is safe and effective.