背景:左侧门静脉高压症(LSPH),也称为左侧门静脉高压症或区域性门静脉高压症,指由脾静脉阻塞或狭窄引起的肝外门静脉高压。正丁基-2-氰基丙烯酸酯(NBC)已广泛应用于门脉高压症的内镜止血,但不良事件包括肾或肺血栓栓塞,治疗后可能发生粘膜坏死和胃肠道(GI)出血。在这里,我们报告了使用改良内镜超声(EUS)引导的选择性NBC注射成功治疗LSPH继发的胃底静脉曲张(GV)出血.
方法:一名35岁男子因上消化道出血被转诊至我院。胃镜检查显示GV出血,计算机断层扫描静脉造影(CTV)证实了LSPH。患者要求进行内窥镜检查,并拒绝包括脾切除术在内的手术治疗。进行EUS指导的选择性NBC注射,并选择胃静脉曲张汇合作为注射部位以减少注射剂量。应用使用未稀释的NBC和高渗葡萄糖的“三明治”方法。无并发症发生。患者出院后定期随访。三个月后,随访胃镜检查显示胃粘膜下层牢固,无NBC排出迹象,随访CTV显示LSPH改善。在此随访期间未报告复发的胃肠道出血。
结论:EUS指导的选择性NBC注射可能是LSPH患者GV出血的一种有效和经济的治疗方法。
BACKGROUND: Left-sided portal hypertension (LSPH), also known as sinistral portal hypertension or regional portal hypertension, refers to extrahepatic portal hypertension caused by splenic vein obstruction or stenosis. N-butyl-2-cyanoacrylate (NBC) has been widely used in the endoscopic hemostasis of portal hypertension, but adverse events including renal or pulmonary thromboembolism, mucosal necrosis and gastrointestinal (GI) bleeding may occur after treatment. Herein, we report successfully managing gastric variceal (GV) hemorrhage secondary to LSPH using modified endoscopic ultrasound (EUS)-guided
selective NBC injections.
METHODS: A 35-year-old man was referred to our hospital due to an upper GI hemorrhage. Gastroscopy revealed GV hemorrhage and computed tomography venography (CTV) confirmed LSPH. The patient requested endoscopic procedures and rejected surgical therapies including splenectomy. EUS-guided
selective NBC injections were performed and confluences of gastric varices were selected as the injection sites to reduce the injection dose. The \"sandwich\" method using undiluted NBC and hypertonic glucose was applied. No complications occurred. The patient was followed up regularly after discharge. Three months later, the follow-up gastroscopy revealed firm gastric submucosa with no sign of NBC expulsion and the follow-up CTV showed improvements in LSPH. No recurrent GI hemorrhage was reported during this follow-up period.
CONCLUSIONS: EUS-guided
selective NBC injection may represent an effective and economical treatment for GV hemorrhage in patients with LSPH.