EUS引导下凝血酶注射和螺旋管植入治疗造口旁静脉曲张后的技术和临床结果。

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY
Andrew Todd, Chander Shekhar, Joanne O'Rourke, Colm Forde, Arvind Pallan, Sharan Suresh Wadhwani, Dhiraj Tripathi, Brinder Singh Mahon
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引用次数: 0

摘要

背景和目的:造口旁静脉曲张出血可导致显著的发病率和死亡率。治疗选择是有限的,特别是在有严重潜在肝病和其他合并症的高危患者中。EUS引导的栓塞线圈联合凝血酶注射治疗胃静脉曲张已被证明是安全有效的。我们机构已经将同样的技术应用于造口旁静脉曲张的治疗。方法:对24例患者的37项手术进行回顾性审查,以评估EUS引导下注射凝血酶(带或不带栓塞线圈)治疗出血性造口旁静脉曲张的疗效和安全性。所有患者都在多学科团队会议上进行了讨论,门静脉高压的纠正被认为是禁忌。再出血被定义为需要入院或输血的吻合口出血。结果:所有患者在转诊时均有明显的造口旁出血。技术成功率达到100%。70.8%的患者在一次手术后的随访期(中位数26.2个月)内没有进一步的显著出血。第一次手术后1年无再出血生存率为80.8%。重复手术7例(29.1%)。重复手术后无再出血生存率没有显著差异。年龄越大,再出血的风险越高。未发现与手术相关的主要并发症。结论:EUS引导的凝血酶注射,带或不带栓塞线圈,是治疗造口旁静脉曲张出血的一种安全有效的技术,尤其是对于门静脉高压症禁忌纠正的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Technical and clinical outcomes following EUS-guided thrombin injection and coil implantation for parastomal varices.

Background and aims: Bleeding from parastomal varices causes significant morbidity and mortality. Treatment options are limited, particularly in high-risk patients with significant underlying liver disease and other comorbidities. The use of EUS-guided embolisation coils combined with thrombin injection in gastric varices has been shown to be safe and effective. Our institution has applied the same technique to the treatment of parastomal varices.

Methods: A retrospective review was performed of 37 procedures on 24 patients to assess efficacy and safety of EUS-guided injection of thrombin, with or without embolisation coils for treatment of bleeding parastomal varices. All patients had been discussed in a multidisciplinary team meeting, and correction of portal hypertension was deemed to be contraindicated. Rebleeding was defined as stomal bleeding that required hospital admission or transfusion.

Results: All patients had significant parastomal bleeding at the time of referral. 100% technical success rate was achieved. 70.8% of patients had no further significant bleeding in the follow-up period (median 26.2 months) following one procedure. 1-year rebleed-free survival was 80.8% following first procedure. 7 patients (29.1%) had repeat procedures. There was no significant difference in rebleed-free survival following repeat procedures. Higher age was associated with higher risk of rebleeding. No major procedure-related complications were identified.

Conclusions: EUS-guided thrombin injection, with or without embolisation coils, is a safe and effective technique for the treatment of bleeding parastomal varices, particularly for patients for whom correction of portal venous hypertension is contraindicated.

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来源期刊
BMJ Open Gastroenterology
BMJ Open Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.90
自引率
3.20%
发文量
68
审稿时长
2 weeks
期刊介绍: BMJ Open Gastroenterology is an online-only, peer-reviewed, open access gastroenterology journal, dedicated to publishing high-quality medical research from all disciplines and therapeutic areas of gastroenterology. It is the open access companion journal of Gut and is co-owned by the British Society of Gastroenterology. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around continuous publication, publishing research online as soon as the article is ready.
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