The Prevent And Control Of The Complications Of Endoscopic Treatment For Gastric Varices With A-cyanoacrylate Alkyl

Objectives:1.To analyse the effect and complication of Endoscopic Treatment For Gastric Varices with a-cyanoacrylate alkyl;2. To investigate the types and characteristics of gastric varices(GV) on CT portal angiography (CTA) and computer-assisted volumetric analysis(CAVA)with GV Volume Measurement;3. To analyse the CAVA method with GV Volume Measurement in the clinical treatment.Methods:1.Analysed retrospectively The clinical data of150(group A)patients with GV treated with endoscopic injection of adhensive a-cyanoacrylate alkyl from Octobe2007to Octobe2010in Portal Hypertension Treatment Center of Hunan(Department of Hepatobiliary Surgery Third Xiangya Hospital Central South University),analysed the effect and the complication.2.Collected100patients of GV(Group B)from November2010to November2011in Portal Hypertension Treatment Center of Hunan(Department of Hepatobiliary Surgery Third Xiangya Hospital Central South University),The GV types, collateral circulation and shunt on CTA were studied in relation to the endoscopic findings; Used the CAVA method with GV volume measurement.3.Analysed12patients in group A that dintraoperative bleeding successful hemostasis, Used the CAVA method with GV volume measurement, Understanded the relationship between the total dose and GV volume; Used the match dose injection with Hypertonic glucose+tissue adhesives+Hypertonic glucose " sandwich " method then calculated GV volume in88patients at the group B,Understanded the Complication that the intraoperatie bleeding,recent recurrent bleeding,and ectopic embolism.Results:1.150GV patients treated with endoscopic injection using a-cyanoacrylate alkyl were collected in group A,GV disappear rate was 56.7%,Reduced rate of36.7%,Emergency hemostasis rate was100%,Recurrent bleeding rate was16.67%(3months). Complication:Intraoperative hemorrhage in12patients (8%),Ectopic embolism15patients(10.71%),include Pulmonary embolism in7patients (5%), Cerebral embolism in5patients (3.6%), Portal vein embolism in2patients (1.4%), Splenic embolism1patient (0.71%); early expulsion of tissue glue bleeding in10patients (7.14%),1patient was death, Sepsis in5patients (3.5%), Gastric ulcer in2patients (1.4%),retrosternal or epigastrium pain, febricity, Leukocytosis reaction in90patients (64.2%).2.The shapes of GV on CTA had three types:circuity, nodosity and nubbly, whichwere highly correlatedwith the findings of the endoscopics (Kappa=0.781,P<0.05).In gastroesophageal varices type-1(GOV-1) the shapes of most GV were circuity, and80%blood supply was often derived from the left gastric veins(LGV),20%with stomach and (or) spleen-kidney shunt, In gastroesophageal varices type-2(GOV-2) the shapes of most GV were nodosity,and80%blood supply was often derived from the left gastric veins(LGV),20%with stomach and (or) spleen-kidney shunt;76.3%blood supply could come from both LGV and posterior gastric vein(PGV) and(or) short gastric vein(SGV),18.2%with stomach and (or) spleen-kidney shunt;In isolated gastric varices(IGV), its shapes were nubbly,25%blood supply could came from the PGV and(or) SGV,10%blood supply could came from both LGV and PGV and(or) SGV,65%with stomach and (or) spleen-kidney shunt; But method measured by manual control, choosed Two radiologists measured with double blind method and paired t-test to assessed the accuracy of the measure results with the CAVA GV Volume Measurement in88patients,27patients were nubbly type,16patients were circuity type,45patients were nodosity type,Two radiologists calculated the GV volume measurement with double blind method,Matching T test found that the correlation is better(r=0.988,r=0.991, r=0.960).3.We found that used CAVA method calculate the GV Volume in the12patients in group A with intraoperatie bleeding is five times the total dose;in group B, the Tissue adhesives dose which injected with Hypertonic glucose+tissue adhesives+Hypertonic glucose " sandwich " method were1/5GV volume, had one patient intraoperatie bleeding, compared with group A had statistical significance(P=0.035), ten patients had recent recurrent bleeding,compared with group A had no statistical significance(P>0.05), had no ectopic embolism occurred.Conclusions:1.Endoscopic Treatment For GV with a-cyanoacrylate alkyl is a highly effective treatment for acute bleeding gastric varices. The major complication included, Intraoperatie bleeding and postoperative row glue bleeding, Serious complication was Ectopic embolization, Although the incidence is not high, but the prognosis is poor, even life-threatening, required to take effective preventive measures.2.CTA was an noninvasive methods, which can reveal the types of portosystem iccorralation and the collateral circulation characteristics, The CAVA method can calculate the GV Volume and provided effective basis for endoscopic treatment.3.Used the CAVA method calculate the GV Volume then injection with Hypertonic glucose+tissue adhesives+Hypertonic glucose " sandwich " method can reduce the intraoperatie bleeding and ectopic embolism.