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金属夹辅助内镜超声引导组织胶注射治疗合并胃肾分流的肝硬化胃静脉曲张患者的效果初探
DOI: 10.12449/JCH240415
伦理学声明：所有患者在治疗前充分知情并签署知情同意书，本研究于2013年1月30日经首都医科大学附属北京地坛医院院伦理委员会审核并通过，批号：京地伦科字〔2021〕-062号。
利益冲突声明：本文不存在任何利益冲突。
作者贡献声明：李坪、魏红山、马佳丽进行课题设计；李坪、马佳丽、艾正琳、胡居龙、蒋煜进行研究实施；周玉玲、梁秀霞进行随访和数据统计分析；马佳丽撰写文章；李坪进行指导和审校。
The preliminary therapeutic effect of endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips in treatment of cirrhotic patients with gastric varices and gastric-renal shunt
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摘要:
目的 探讨金属夹辅助内镜超声引导组织胶注射治疗合并胃肾分流的胃静脉曲张患者的效果及安全性。 方法 纳入2023年2月—2023年6月因肝硬化伴胃静脉曲张于首都医科大学附属北京地坛医院就诊，证实存在胃肾分流（GRS），并接受金属夹辅助内镜超声引导组织胶注射治疗的患者。主要的评价指标是术后曲张静脉减轻或消失情况，次要评价指标为手术完成情况及并发症。 结果 共11例合并GRS的胃静脉曲张患者纳入研究，男7例，女4例；中位年龄55岁；肝功能Child-Pugh A级1例，Child-Pugh B级7例，Child-Pugh C级3例；分流道最大直径（中位）8 mm，最小直径（中位）4 mm。治疗前靶血管血流中位流速11 cm/s，金属夹阻断后靶血管中位流速5 cm/s；中位组织胶使用量2 mL，聚桂醇使用量均为1 mL。所有患者手术结束后血流信号100%消失，手术成功率100%。随访6周患者均无再出血发生。术后1个月复查胃镜示静脉曲张根除或基本消失9例，静脉曲张改善2例。 结论 对于合并GRS的胃静脉曲张肝硬化患者，金属夹辅助内镜超声引导组织胶注射治疗是一种可行，安全，有效的方法。 Abstract:Objective To investigate the safety and efficacy of endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips in the treatment of cirrhotic patients with gastric varices and gastric-renal shunt （GRS）. Methods The patients who attended Beijing Ditan Hospital， Capital Medical University， due to liver cirrhosis and gastric varices from February to June 2023 were enrolled， and all patients were confirmed to have GRS and received endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips. The primary evaluation index was alleviation or disappearance of varicose veins after surgery， and the secondary evaluation indices were surgical completion and complications. Results A total of 11 patients were enrolled in this study， among whom there were 7 male patients and 4 female patients， with a median age of 55 years. Of all patients， 1 had Child class A liver function， 7 had Child class B liver function， and 3 had Child class C liver function. The maximum （median） diameter of the shunt was 8 mm， and the minimum （median） diameter of the shunt was 4 mm. The median blood flow velocity of the target vessel was 11 cm/s before treatment and 5 cm/s after occlusion with metal clips. The median amount of tissue adhesive injected was 2 mL， and the amount of lauromacrogol used was 1 mL. Disappearance of blood flow signals was observed in all patients after surgery （100%）， and the success rate of surgery was 100%. No patient experienced rebleeding after follow-up for 6 weeks. Gastroscopy at 1 month after surgery showed that gastric varices were eradicated or almost disappeared in 9 patients and were alleviated in 2 patients. Conclusion Endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips is a feasible， safe， and effective treatment method for cirrhotic patients with gastric varices and GRS. -
Key words:
- Liver Cirrhosis /
- Esophageal and Gastric Varices /
- Metal Clips
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图 1 患者治疗前后的内镜表现
注： a，合并GRS的IGV1内镜治疗前；b，IGV1金属夹阻断血流；c，金属夹辅助内镜超声引导组织胶注射治疗1周后；d，治疗1周后，靶血管彻底实变；e、f：金属夹辅助内镜超声引导组织胶注射治疗1个月后。
Figure 1. The endoscopic findings of patients before and after treatment
图 2 内镜超声引导组织胶注射治疗胃静脉曲张的过程
注： a，内镜超声探查并确定靶血管，测量靶血管内径；b，内镜超声测量靶血管血流速度；c，内镜超声引导下穿刺针进入靶血管内；d，内镜超声引导下，“三明治”法组织胶注射栓塞靶血管；e、f，内镜超声探测靶血管血流信号消失。
Figure 2. The process of endoscopic ultrasound guided tissue glue injection for the treatment of gastric varices
表 1 11例合并GRS的胃静脉曲张肝硬化患者基本资料及金属夹辅助内镜超声引导组织胶注射治疗情况
Table 1. The data of 11 cirrhotic patients with gastric varices and GRS who received the treatment of endoscopic ultrasound guided tissue glue injection with the assistant of metal clips
编号 性别 年龄（岁） 病因 Child-Pugh 分级 分流道最大直径（mm） 分流道最小直径（mm） 靶血管最大直径（mm） 金属夹数量（个） 聚桂醇用量（mL） 组织胶使用量（mL） 随访时间（d） 并发症情况 静脉曲张改善情况 1 男 55 乙型肝炎 B 7 2 8.5 2 1 2 225 无 基本消失 2 男 40 乙型肝炎 B 9 3 9.6 3 1 2 216 无 基本消失 3 女 54 乙型肝炎 B 8 4 9.3 3 1 2 212 无 基本消失 4 女 65 乙型肝炎 A 8 3 12.2 2 1 3 208 无 基本消失 5 男 67 酒精性肝病 C 6 3 8.9 2 1 2 194 腹腔感染 改善 6 女 49 丙型肝炎 B 7 4 9.8 3 1 2 152 无 基本消失 7 男 61 乙型肝炎 B 10 6 13.0 4 1 3 143 无 基本消失 8 女 64 乙型肝炎 B 7 3 10.1 3 1 3 93 无 基本消失 9 男 60 丙型肝炎 C 9 5 11.5 2 1 3 69 无 改善 10 男 52 乙型肝炎 C 9 5 8.5 2 1 2 54 无 基本消失 11 男 53 丙型肝炎 B 10 6 12.8 4 1 3 47 无 基本消失 
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