Long-term follow-up of gastric variceal sclerotherapy: An eleven-year experience
Long-term follow-up of gastric variceal sclerotherapy: An eleven-year experience
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DOI：
10.1016/s0016-5107(97)70202-5
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发表时间：
1997-07-01
影响因子：
7.7
通讯作者：
Sarin, SK
中科院分区：
文献类型：
--
作者：
Sarin, SK
背景：胃静脉曲张出血通常是一种严重的内科急症。内镜在胃静脉曲张出血治疗中的作用仍有争议。方法：观察209例门静脉高压症患者的胃底静脉曲张。71例患者（肝硬化33例，非肝硬化38例）接受了胃静脉曲张硬化治疗，其中53例（75%）为胃静脉曲张出血。通过使用先前描述的分类，胃静脉曲张分为胃食管静脉曲张1型（GOV 1）和2型（GOV 2），以及孤立的胃静脉曲张1型（IGV 1）。结果：18例患者中，急诊胃静脉曲张硬化治疗后12例（66.7%）急性出血停止。60例接受重复选择性硬化治疗的患者中有43例（71.6%）实现了静脉曲张闭塞。GOV 1组的静脉曲张闭塞率（94.4%）高于GOV 2组（70.4%）和IGV 1组（41%）。在三种类型的胃静脉曲张中，选择性胃静脉曲张硬化治疗后再出血的发生率分别为5.5%、19%和53%。在平均随访24.2 +/- 22.9个月期间未观察到胃静脉曲张复发。17例（24%）患者死亡，几乎同样的再出血和肝功能failure.Conclusions：（1）硬化治疗可以有效地阻止急性胃静脉曲张出血，实现胃静脉曲张闭塞，（2）它是更有效的胃食管静脉曲张患者，（3）替代疗法需要评估IGV 1患者。
Background: Bleeding from gastric varices is often a serious medical emergency. The role of endoscopy in the management of gastric variceal bleeding is still controversial. The types of gastric varices and their respective management strategies have not been identified.Methods: Gastric varices were observed in 209 patients with portal hypertension. Seventy-one patients (with cirrhosis 33, noncirrhotic 38) underwent gastric variceal sclerotherapy, 53 of these (75%) for gastric variceal bleeding. By use of a previously described classification, gastric varices were divided into gastroesophageal varices, type 1 (GOV1) and type 2 (GOV2), and isolated gastric varices, type 1 (IGV 1). Gastric variceal sclerotherapy was done every week using a combination technique of paravariceal and intravariceal injections with absolute alcohol.Results: Emergency gastric variceal sclerotherapy arrested acute bleeding in 12 (66.7%) of 18 patients. Variceal obliteration was achieved in 43 of the 60 (71.6%) patients who underwent repeated elective sclerotherapy. Variceal obliteration was higher in patients with GOV1 (94.4%) than in those with GOV2 (70.4%) and IGV1 (41%). Rebleeding after elective gastric variceal sclerotherapy was seen in 5.5%, 19%, and 53%, respectively, in the three types of gastric varices. Gastric variceal recurrence was not seen during a mean follow-up of 24.2 +/- 22.9 months. Seventeen (24%) patients died, nearly equally from rebleeding and liver failure.Conclusions: (1) Sclerotherapy can effectively arrest acute gastric variceal bleeding and achieve gastric variceal obliteration, (2) it is more effective in patients with gastroesophageal varices, and (3) alternative therapies need to be evaluated for patients with IGV1.