内镜下组织粘合剂注射治疗胃底静脉曲张致门静脉栓塞1例及文献复习

Endoscopic tissue adhesive injection in treatment of portal thrombosis due to varices of gastric fundus: A case report and literature review

  • 摘要: 目的 探讨内镜下组织粘合剂注射治疗胃底静脉曲张致异位栓塞的防治。 方法 对1例内镜下组织粘合剂注射治疗胃底静脉曲张致门静脉栓塞的病例进行回顾性分析并结合文献复习。 结果 该患者因呕血、黑便于2012年5月2日入院,经内镜检查为胃底静脉曲张破裂出血,给予内镜下组织粘合剂注射治疗后成功止血,但术后转氨酶及胆红素较前异常升高,经检查并发门静脉异位栓塞,经保肝等对症治疗4周后,肝功能恢复正常。 结论 内镜下组织粘合剂注射治疗胃底静脉曲张术前应对患者进行充分评估,确定是否存在胃-肾、胃-腔分流通道,以及胃底曲张静脉的大小,注射过程中要把握注射速度及组织粘合剂剂量,谨防异位栓塞的发生。

     

    Abstract: Objective To study the endoscopic tissue adhesive injection in prevention and treatment of ectopic embolism due to varices of gastric fundus. Methods A case of ectopic embolism due to varices of gastric fundus who was treated with endoscopic tissue adhesive injection was reported and retrospectively analyzed with related literature reviewed. Results The patient was admitted to our hospital on May 2, 2012 for hematemesis and melena and was diagnosed with upper gastrointestinal bleeding due to ruptured varices of gastric fundus by endoscopy.The bleeding was stopped after endoscopic tissue adhesive injection, but the transaminase and bilirubin levels were significantly higher after treatment than before treatment.Physical examination showed that the patient was complicated by ectopic portal embolism.The liver function of the patient became normal 4 weeks after liver protection therapy. Conclusion Patients with varices of gastric fundus should be fully assessed before endoscopic tissue adhesive injection to determine whether there are stomach-kidney and stomach-shunt channels, and the size of varices of gastric fundus.Care must be taken for the injection speed and dose of tissue adhesive in order to prevent the occurrence of ectopic embolism.

     

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