聚桂醇泡沫硬化治疗下肢静脉曲张562例分析

目的探讨无超声引导下聚桂醇泡沫硬化治疗下肢静脉曲张的临床效果。方法 2009年10月～2011年4月对562例下肢曲张静脉穿刺进行聚桂醇泡沫硬化注射治疗,硬化剂泡沫使用20 ml注射器抽取10 ml空气注入含10 ml聚桂醇的安瓿瓶反复抽吸形成,再将10 ml含泡沫硬化剂的注射器与6号头皮针相连,硬化治疗下肢静脉曲张562例共613条患肢。结果 1周后复查曲张静脉触诊均变成硬条索状,未有触及软的曲张静脉,3个月后患者未诉有明显曲张静为治愈,1个疗程聚桂醇泡沫硬化治疗后治愈率98.2%（602/613）,2个疗程治疗后治愈率100%。并发症发生率12.3%（69/562）,其中干咳为主要并发症,占10.1%（57/562）。结论无超声引导聚桂醇泡沫硬化治疗下肢静脉曲张操作简单、有效、微创、安全。     

聚桂醇注射联合大隐静脉抽剥缝扎治疗下肢静脉曲张

目的:探讨国产聚桂醇注射联合大隐静脉抽剥缝扎治疗下肢静脉曲张的临床效果.方法:选择我院从2010年4月至2011年8月应用大隐静脉主干抽剥联合聚桂醇泡沫硬化剂治疗下肢静脉曲张47条肢体,观察大隐静脉曲张的治疗效果.结果:47条肢体中42条肢体治疗2周后曲张静脉完全闭塞;5条肢体残留少许曲张静脉,再次注射后闭塞;6个月后复诊均无明显复发.结论:国产聚桂醇泡沫硬化剂注射联合大隐静脉抽剥缝扎治疗下肢静脉曲张的临床效果满意,是微创治疗下肢静脉曲张的新方法.     

聚桂醇泡沫硬化剂治疗下肢静脉曲张200例临床分析

目的:探讨聚桂醇泡沫硬化剂治疗下肢静脉曲张的效果。方法:对200例下肢曲张静脉进行聚桂醇泡沫硬化剂注射治疗,观察术后治疗效果。结果:298条肢体均成功注射,平均每条肢体应用6~8 ml泡沫硬化剂。平均随访6个月,下肢活动后酸胀、乏力感均消失,曲张静脉消失;小腿局限轻度曲张3例。结论:新型泡沫硬化剂治疗大隐静脉曲张,方便、有效、痛苦小、无瘢痕形成、无严重并发症,可重复进行,近期疗效佳。     

内镜下硬化与套扎治疗食管静脉曲张破裂出血疗效比较

目的：对比内镜下硬化治疗（EIS）、套扎治疗（EVL）及套扎联合硬化治疗（ESL）3种方法对食管静脉曲张破裂出血的临床疗效。方法：回顾分析中日友好医院消化内科2001—2005年内镜下治疗肝硬化单纯食管静脉曲张破裂出血149例,其中EIS46例、EVL32例、ESL71例,对3种方法的止血率、静脉曲张消失率及再出血率进行比较。结果：3种治疗方法止血率均在90%以上;静脉曲张消失率分别为EIS80.4%、EVL68.8%、ESL87.3%;2年内再出血率分别为EIS52.2%、EVL59.3%、ESL43.6%,差异无统计学意义（P〉0.05）。结论：内镜下EIS、EVL及ESL治疗肝硬化食管曲张静脉出血均可达到较好效果,临床实践中可结合患者实际情况综合考虑后选择。     

聚桂醇硬化注射治疗内痔的临床疗效

为探讨聚桂醇硬化注射治疗内痔的临床疗效,将120例内痔患者随机分为治疗组和对照组,各60例,治疗组给予聚桂醇硬化注射,对照组给予消痔灵硬化注射,对比两组总体疗效和并发症。结果显示,两组总有效率比较差异无统计学意义,P〉0．05;但治疗组治疗后肛门坠胀感、肛门疼痛、肛门狭窄、黏膜坏死发生率明显低于对照组,P＜0．05。结果表明,聚桂醇硬化注射治疗内痔疗效肯定,并发症少,优于消痔灵。     

RPH联合聚桂醇注射治疗内痔出血并直肠黏膜内脱垂29例疗效观察

目的:观察自动弹力线痔套扎术(RPH)联合聚桂醇注射治疗内痔出血并直肠黏膜内脱垂的疗效。方法:选取2018年1月至2021年3月,本院治疗的58例内痔出血并直肠黏膜内脱垂患者,随机分为治疗组和对照组,每组各29例。治疗组采用RPH联合聚桂醇注射治疗,对照组予传统外剥内扎术联合聚桂醇注射治疗。比较2组术后疼痛、出血及疗效等情况。结果:治疗组总有效率为93.1%,高于对照组的72.4%(P<0.05)。治疗组术后疼痛、出血和水肿程度等评分均低于对照组(P<0.05),创面愈合时间短于对照组(P<0.05)。结论:RPH联合聚桂醇注射治疗内痔出血并直肠黏膜内脱垂疗效确切,术后疼痛小,出血量少,创面愈合时间短,能有效改善出血及黏膜脱垂情况。     

下肢静脉曲张手术联合聚桂醇泡沫疗法78例护理

目的:总结下肢静脉曲张围手术期的护理,探讨大隐静脉主干剥脱联合聚桂醇泡沫硬化剂治疗后相应的护理对策。方法:对78例下肢静脉曲张大隐静脉曲张患者主干剥脱术联合聚桂醇泡沫疗法围手术期进行细致、耐心的护理,观察护理效果,分析总结护理经验。结果:经过大隐静脉主干剥脱联合聚桂醇泡沫硬化剂治疗,患者术后下肢症状及体征包括酸胀、色素沉着、疼痛等不适症状均有极大的改善,获得了较好的效果。结论:针对下肢静脉曲张的常见性、危险性以及手术的关键性、护理难度大等特点,进行严密的观察和细致的护理是治疗成功的关键。     

TST结合聚桂醇硬化注射治疗混合痔的临床疗效

为探讨选择性痔上黏膜切除钉合术（TST）结合聚桂醇硬化注射治疗混合痔的临床疗效,将2011年9月至2012年9月我科收治的60例混合痔患者随机分为观察组和对照组,各30例,观察组予TST加聚桂醇硬化注射治疗,对照组予传统外剥内扎术治疗,对比两组患者总体疗效、住院时间、手术时间、术中出血量、术后并发症、复发情况等。结果显示,两组患者总体疗效比较差异无统计学意义,P〉0．05;但观察组患者在住院时间、手术时间、术中出血量、术后疼痛评分、肛缘水肿、便血等方面均优于对照组,P〈0．05。术后随访6～18个月,观察组复发1例,对照组复发3例,差异无统计学意义,P〉0.05。两组患者均未见术后感染、吻合口或肛门狭窄、肛门失禁、直肠阴道瘘等并发症。结果表明,TST结合聚桂醇硬化注射治疗混合痔疗效显著,且手术操作简便、安全,术后并发症少,值得临床推广应用。     

超声引导下聚桂醇硬化剂注射治疗大隐静脉曲张的疗效观察

目的 探讨超声引导下聚桂醇硬化剂注射治疗大隐静脉曲张的临床疗效.方法 收集2019年5月至2021年2月在保定市第二医院接受治疗的大隐静脉曲张患者的临床资料,根据治疗方式的不同将其分为手术组(采用大隐静脉高位结扎剥脱术治疗)和硬化组(采用超声下聚桂醇硬化剂注射治疗),每组65例.比较两组患者的术后下肢静脉曲张临床表现-...     

聚桂醇注射液治疗大隐静脉曲张78例临床疗效观察

目的:观察国产新型硬化剂聚桂醇注射液治疗下肢静脉曲张的临床效果.方法:78例下肢静脉曲张患者90条肢体,其中60条重度下肢静脉曲张患者采用点状抽剥联合聚桂醇泡沫硬化,30条轻度静脉曲张采用直接注射聚桂醇泡沫硬化剂加压包扎或穿弹力袜.结果:术后1个月,点状抽剥加硬化剂治疗的60条肢体和单纯泡沫硬化剂治疗30条肢体,全部下肢肿痛乏力感消失,皮肤瘙痒感减轻,下肢静脉曲张畸形消失.结论:新型泡沫硬化剂是治疗下肢静脉曲张的有效药物.     

肝硬化伴食管静脉曲张破裂出血行脾切除加断流治疗与内镜治疗的疗效对比分析

目的探讨外科手术治疗(脾切除+门奇静脉断流术)与内镜下治疗(内镜下套扎和硬化剂治疗)对肝硬化所致食管静脉曲张破裂出血的疗效,并寻找导致术后再出血的危险因素。方法回顾性分析陆军军医大学大坪医院2012年1月至2017年11月收治的肝硬化伴食管静脉曲张破裂出血病人的资料。将行脾切除、门奇静脉断流术者纳入外科手术治疗组(54例);将内镜下行套扎、硬化剂治疗者纳入内镜治疗组(63例)。根据搜集所得资料及电话随访结果,统计病人治疗后的再出血率、治疗后再出血的平均间隔时间等。数据采用SPSS(23.0版)软件进行处理。结果手术治疗组术后1、3、5年再出血率分别为9.3%、20.5%、23.1%,内镜治疗组术后1、3、5年再出血率分别为39.7%、73.0%、74.8%,手术治疗组再出血率明显低于内镜治疗组(P<0.001)。COX多因素分析显示:内镜治疗术后再出血的风险是手术治疗的7.2倍(P<0.001)。曲张的食管静脉距门齿的距离、脾脏的大小、脾功能亢进的程度与术后再出血与否无统计学相关性。结论外科手术治疗相比内镜治疗可更好地控制曲张食管静脉的破裂出血,其1、3、5年再出血率明显小于内镜治疗组。治疗方式是病人术后再次出血的危险因素。     

Effect of aluminum phosphate gel on prevention of early rebleeding after ligation of esophageal variceal hemorrhage

BACKGROUNDLiver cirrhosis is the main cause of portal hypertension. The leading cause of death in patients with liver cirrhosis is its most common complication, esophageal variceal bleeding (EVB). Endoscopic variceal ligation (EVL) is recommended by many guidelines to treat EVB and prevent rebleeding; however, esophageal ulcers occur after treatment. Delayed healing of ulcers and unhealed ulcers lead to high rebleeding and mortality rates. Thus, the prevention of early postoperative rebleeding is of great significance in improving the quality of life and prognosis of patients.AIMTo evaluate the efficacy of aluminum phosphate gel (APG) plus a proton pump inhibitor (PPI) in the prevention of early rebleeding after EVL in patients with EVB.METHODSThe medical records of 792 patients who were diagnosed with EVB and in whom bleeding was successfully stopped by EVL at Shenzhen People’s Hospital, Guangdong Province, China from January 2015 to December 2020 were collected. According to the study inclusion and exclusion criteria, 401 cases were included in a PPI-monotherapy group (PPI group), and 377 cases were included in a PPI and APG combination therapy (PPI + APG) group. We compared the incidence rates of early rebleeding and other complications within 6 wk after treatment between the two groups. The two-sample t-test, Wilcoxon rank-sum test, and chi-squared test were adopted for statistical analyses.RESULTSNo significant differences in age, sex, model for end-stage liver disease score, coagulation function, serum albumin level, or hemoglobin level were found between the two groups. The incidence of early rebleeding in the PPI + APG group (9/337; 2.39%) was significantly lower than that in the PPI group (30/401; 7.48%) (P = 0.001). Causes of early rebleeding in the PPI group were esophageal ulcer (3.99%, 16/401) and esophageal varices (3.49%, 14/401), while those in the PPI + APG group were also esophageal ulcers (5/377; 1.33%) and esophageal varices (4/377; 1.06%); such causes were significantly less frequent in the PPI + APG group than in the PPI group (P = 0.022 and 0.024, respectively). The early mortality rate within 6 wk in both groups was 0%, which was correlated with the timely rehospitalization of all patients with rebleeding and the conduct of emergency endoscopic therapy. The incidence of adverse events other than early bleeding in the PPI + APG group (28/377; 7.43%) was significantly lower than that in the PPI group (63/401; 15.71%) (P < 0.001). The incidence of chest pain in the PPI + APG group (9/377; 2.39%) was significantly lower than that in the PPI group (56/401; 13.97%) (P < 0.001). The incidence of constipation in the PPI + APG group (16/377; 4.24%) was significantly higher than that in the PPI group (3/401; 0.75%) (P = 0.002) but constipation was relieved after patients drank more water or took lactulose. In the PPI and PPI + APG groups, the incidence rates of spontaneous peritonitis within 6 wk after discharge were 0.50% (2/401) and 0.53% (2/377), respectively, and those of hepatic encephalopathy were 0.50% (2/401) and 0.27% (1/377), respectively, presenting no significant difference (P > 0.999).CONCLUSIONPPI + APG combination therapy significantly reduces the incidence of early rebleeding and chest pain in patients with EVB after EVL.     

Technique and early clinical results of endoscopic variceal ligation (EVL)

Summary Endoscopic variceal ligation (EVL) is a new technique designed to be used instead of sclerotherapy. Small elastic O rings ligate varices resulting in their strangulation and eradication. During a 12-month period, EVL was employed in 53 consecutive patients, of whom 36 (68%) had alcoholic cirrhosis 17 were Child-Pugh class A, 22 class B, and 14 class C. Varices were graded from I to IV and repeat treatments were given at 1–2 week intervals until the varices were eliminated. At follow-up ranging from 6–18 months (mean 11.5), 217 EVL treatment sessions had been performed. Of the 13 patients (24%) who died during the study, 11 died during the index hospitalization. Active bleeding was controlled in 19 of 21 patients (90%). Of 40 survivors 13 patients (33%) had 1–2 (mean 1.4) recurrent variceal bleeds while 34 patients had repeat EVL treatment. Elimination of distal varices was achieved in 26 and 7 had reduction of varices from grade III–IV to grade I–II or less. Eradication required a mean of 4.4 EVL sessions in Child's A and B patients and 7.0 sessions in Child's C patients (P<0.025). No significant treatment-related complications were observed. EVL appears to control active bleeding, is associated with a low incidence of non-bleeding complications, and may be used as an alternative to sclerotherapy.     

贲门周围血管离断术加内镜下曲张静脉套扎术治疗门静脉高压症

１９９３年以来,我院应用贲门周围血管离断术加内镜下曲张静脉套扎术治疗门静脉高压症６６例。结果：术后食管胃底静脉曲张消失率９５．５％（６３／６６）,无手术死亡,无严重并发症,远期再出血率为４．７％（３／６４）,无肝性脑病发生,三年生存率达９０．２％。我们认为此种联合断流术可降低术后再出血率,且不增加手术复杂性及手术创伤,适应证与单独应用贲门周围血管离断术同样广泛。     

内镜下治疗伴发静脉曲张的上消化道早癌患者的出血风险

目的研究内镜下治疗伴发食管胃静脉曲张的上消化道早癌患者的出血风险。方法回顾性分析2005年4月至2011年8月行内镜下治疗伴发食管胃底静脉曲张的7例上消化道早癌患者的临床资料。静脉曲张采用LDRf分型进行分型。对于早癌或癌前病变采用内镜下黏膜剥离术（ESD）或内镜下黏膜切除术（EMR）治疗。结果本组7例患者行ESD或EMR,7例患者中4例早期胃癌,3例早期食管癌;6例食管静脉曲张,1例胃底静脉曲张。均完整切除病变,内镜下早癌治疗术中及术后均未发生静脉曲张出血。结论内镜下治疗伴发食管胃静脉曲张的上消化道早癌不增加静脉曲张的出血风险。     

Effects of postoperative use of proton pump inhibitors on gastrointestinal bleeding after endoscopic variceal treatment during hospitalization

BACKGROUND Endoscopic variceal treatment(EVT) is recommended as the mainstay choice for the management of high-risk gastroesophageal varices and acute variceal bleeding in liver cirrhosis. Proton pump inhibitors(PPIs) are widely used for various gastric acid-related diseases. However, the effects of PPIs on the development of post-EVT complications, especially gastrointestinal bleeding(GIB), remain controversial.AIM To evaluate the effects of postoperative use of PPIs on post-EVT complications i...     

食管曲张静脉内镜套扎术对门静脉高压性胃病的影响

目的探讨食管曲张静脉内镜套扎术(esophageal variceal ligation, EVL)对门静脉高压性胃病(portal hypertensive gastropathy, PHG)的影响. 方法对37例PHG在EVL治疗前后进行胃镜观察. 结果 PHG严重程度与肝功能状态有关,PHG发生率Child C级(100%,9/9)高于A级(60%,12/20)与B级(80%,16/20)(χ2=18.452,P=0.001).EVL治疗可以使PHG加重,但统计学无显著性差异(χ2=3.512,P＝0.173).6～12个月复查胃镜,无食管曲张静脉复发及破裂出血,无胃黏膜出血. 结论肝功能越差,PHG发生率越高.EVL治疗对PHG的影响呈动态性变化,EVL治疗后PHG有加重趋势.     

瑞马唑仑和丙泊酚用于肝硬化患者内镜下静脉曲张套扎术的比较

目的 探讨瑞马唑仑和丙泊酚对肝硬化患者内镜下静脉曲张套扎术血流动力学和不良反应的影响。
方法 纳入拟行内镜下静脉曲张套扎术的肝硬化患者96例,男43例,女53例,年龄18～70岁,BMI 18.5～27.9 kg/m²,ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：瑞马唑仑组（R组）和丙泊酚组（P组）,每组48例。R组静脉注射瑞马唑仑0.2 mg/kg行麻醉诱导,静脉泵注瑞马唑仑1～2 mg·kg^-1·h^-1行麻醉维持;P组静脉注射丙泊酚2 mg/kg行麻醉诱导,静脉泵注丙泊酚4～10 mg·kg^-1·h^-1行麻醉维持。记录麻醉诱导前（T₀）、麻醉诱导后（T₁）、气管插管后（T₂）、手术开始后5 min（T₃）、拔管后（T₄）的HR和MAP。记录患者意识消失时间、拔管时间、意识恢复时间、PACU停留时间。记录术前、术后1 d谷氨酸-丙酮酸转氨酶（ALT）、天门冬氨酸氨基转移酶（AST）。记录术中低血压、术后低氧血症、头晕、恶心呕吐、苏醒延迟、苏醒期躁动的发生情况。
结果 与P组比较,R组T₁—T₃时HR、MAP明显升高（P＜0.05）,意识消失时间明显延长（P＜0.05）,拔管时间、意识恢复时间和PACU停留时间明显缩短（P＜0.05）,术中低血压、术后低氧血症发生率明显降低（P＜0.05）。两组T₀、T₄时HR、MAP差异无统计学意义。两组术后1 d ALT、AST和头晕、恶心呕吐、苏醒延迟、苏醒期躁动发生率差异均无统计学意义。
结论 与丙泊酚比较,瑞马唑仑对行内镜下静脉曲张套扎术肝硬化患者的血流动力学影响较小,可明显降低低血压发生率,安全性较高。     

Hassab手术联合食管曲张静脉套扎术治疗食管曲张血管破裂出血

目的观察Hassab手术联合食管曲张静脉套扎术治疗门静脉高压症食管静脉曲张破裂出血的临床疗效。方法将近5年间收治的93例门静脉高压症食管静脉曲张破裂出血的患者随机分成3组，分别实施单纯性内窥镜食管曲张静脉套扎术（endoscopic variceal ligation，EVL）、贲门周围血管离断术（Hassab手术）及EVL联合Hassab手术（联合治疗组），对其临床效果进行比较分析。结果3组急性止血率无差异（P〉0．05）；联合手术组术后近期无出血，远期再出血率为5．7％明显低于EVL组和Hassab手术组（P〈0．05）；术后EVL组、Hassab手术组、联合手术组的奇静脉血流量分别下降22．7％，30．4％，45．7％。结论联合手术组同时阻断了胃食管腔内外的异常门奇静脉分流，食管曲张静脉获得根治，且有脾功能亢进消失、奇静脉血流量降低明显、止血效果确切、再出血率低等优点，是治疗门静脉高压症食管静脉曲张破裂出血的合理而可行的术式。