门脉源性食管出血的内镜预防和治疗

B. Bebezov, R. A. Sultangaziev, T. Abdykadyrov
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Endoscopic ligation is a modern minimally invasive and less traumatic intervention used to markedly reduce mortality and improve quality of life in patients with portal hypertension syndrome. The evidence on 76 patients following endoscopic OV ligation was summarised. The patient age ranged from 11 to 70 years (mean 46.26 years); 40 men (52.6 %) and 36 women (47.4 %) were included. Among the 76 patients, portal hypertension was caused by viral cirrhosis in 38, hepatitis B in 5, delta agent hepatitis B in 18, hepatitis C in 13, a hepatitis B–C combination in 1 and a delta agent hepatitis B — hepatitis C combination in 1 patient. In 21 patients, cirrhosis was of unknown aetiology. A portal vein malformation was observed in 13 people of whom 4 had it combined with thrombosis.Results. A total of 94 ligation procedures were performed in 76 patients with grade II–III OV. Some patients needed to undergo the procedure several times, 18 patients had 2 sessions. 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引用次数: 0

摘要

背景门静脉高压引发的食道和胃静脉曲张破裂出血是最危险和最具威胁性的并发症,第一次发作时死亡率高达50-70%。30-50%的患者随后出现高死亡率的反复出血,第一次发作后的头两年内复发率为100%。世界经验要求进一步研究,以开发新的手术方法和方法。目的:评价内镜下气动带扎治疗食管静脉曲张破裂出血的疗效。材料和方法。分析了2017年至2019年期间在吉尔吉斯斯坦共和国总统府临床医院普通外科管理的患者中应用气动内镜结扎治疗的经验。内镜结扎是一种现代微创、创伤较小的干预措施,用于显著降低门静脉高压综合征患者的死亡率和提高生活质量。总结了76例内镜下OV结扎术后患者的证据。患者年龄11~70岁,平均46.26岁;包括40名男性(52.6%)和36名女性(47.4%)。在76名患者中,门静脉高压是由病毒性肝硬化引起的38例,乙型肝炎5例,德尔塔试剂乙型肝炎18例,丙型肝炎13例,乙型-丙型肝炎合并症1例,以及德尔塔试剂乙肝-丙型肝炎联合症1例。21例患者的肝硬化病因不明。在13人中观察到门静脉畸形,其中4人合并血栓形成。后果76名II–III级OV患者共进行了94次结扎手术。一些患者需要进行多次手术,18名患者进行了2次手术。两个案例分别需要3次和4次疗程。据报道,32名患者在结扎后1-6天内出现中度食道疼痛。术中未发现并发症。在术后早期,2名患者出现复发性出血,通过反复结扎出血下方的静脉重新止血。结论因此,微创、创伤小,加上高效、并发症少,使内镜结扎成为OV一级和二级预防和治疗的首选方法。内镜结扎可以提高患者的生活质量,为保守治疗提供额外的时间,并延长肝移植的时间。
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Endoscopic Prophylaxis and Treatment of Portal-Genesis Oesophageal Haemorrhage
Background. Portal hypertension-triggered oesophageal and gastric variceal bleeding is the most dangerous and threatening complication, with an up to 50–70 % mortality at first episode. High-mortality repeated bleeding develops subsequently in 30–50 % patients, with the proved 100 % recurrence rate in the first two years following the first episode. The world experience dictates further research to continue towards developing new surgical methods and approaches.Aim: to evaluate the treatment efficacy of pneumatic endoscopic band ligation of bleeding oesophageal varices (OV).Materials and methods. The experience of applying pneumatic endoscopic ligation treatment in the patients managed at the General Surgery Unit of the Clinical Hospital of the Kyrgyz Republic Presidential Administration during 2017–2019 was analysed. Endoscopic ligation is a modern minimally invasive and less traumatic intervention used to markedly reduce mortality and improve quality of life in patients with portal hypertension syndrome. The evidence on 76 patients following endoscopic OV ligation was summarised. The patient age ranged from 11 to 70 years (mean 46.26 years); 40 men (52.6 %) and 36 women (47.4 %) were included. Among the 76 patients, portal hypertension was caused by viral cirrhosis in 38, hepatitis B in 5, delta agent hepatitis B in 18, hepatitis C in 13, a hepatitis B–C combination in 1 and a delta agent hepatitis B — hepatitis C combination in 1 patient. In 21 patients, cirrhosis was of unknown aetiology. A portal vein malformation was observed in 13 people of whom 4 had it combined with thrombosis.Results. A total of 94 ligation procedures were performed in 76 patients with grade II–III OV. Some patients needed to undergo the procedure several times, 18 patients had 2 sessions. Two cases required 3 and 4 sessions each. Moderate oesophageal soreness was reported in 32 patients for 1–6 days following the ligation. No complications were registered during the operation. In early postoperative period, 2 patients developed recurrent bleeding, with haemostasis re-achieved by a repeated vein ligation below bleeding.Conclusion. Hence, small invasiveness and minor traumatism coupled with high efficiency and lesser complications render endoscopic ligation the method of choice in primary and secondary prophylaxis and treatment of OV. Endoscopic ligation improves the patient’s quality of life, allows an extra time for conservative treatment and longer period to liver transplantation.
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