内镜下胃静脉套扎术治疗肝硬化门静脉高压急性胃底静脉曲张出血的随机对照研究  

A randomized controlled trial of endoscopic treatment of acute gastric variceal hemorrhage:n-butyl-2-cyanoacrylate injection versus band ligation

作　　者：郑丰平[1] 郭云蔚[1] 林显艺[1] 文卓夫[1] 吴斌[1] 

机构地区：[1]中山大学附属第三医院消化内科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2012年第2期48-52,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省科技计划(2008B030301038)

摘　　要：目的探讨内镜下胃底静脉曲张套扎术（GVL）治疗肝硬化门静脉高压症患者胃底静脉曲张破裂出血的临床疗效。方法本组前瞻性研究对象为2008年7月至2012年3月在中山大学附属第三医院因肝硬化门静脉高压急性上消化道出血，经急诊电子胃镜（胃镜）检查证实符合入选标准的58例患者。患者均签署知情同意书，符合医学伦理学规定。男性48例，女性10例。按单双号随机分组，GVL组28例，胃底静脉曲张组织粘合剂栓塞（GVO）组30例。对患者进行随访复查，临床疗效评估指标包括24h止血率、再出血率、胃底静脉曲张基本消失率、胃底静脉曲张缓解率、并发症发生率和死亡率。临床疗效评估指标比较采用矿检验。结果GVL组胃曲张静脉套扎（3．5±1．4）环，GVO组根据曲张静脉团的直径大小，每点注射组织黏合剂1-3（中位数2）ml，注射点数1-4（中位数2）点。GVL组与GVO组分别有15例和11例急性活动性出血，24h止血率均为100％。两组胃底静脉曲张治疗的总有效率分别为72％（20／28）、70％（21／30）；GVL组和GVO组胃底静脉曲张的基本消失率分别为29％（8／28）和27％（8／30），缓解率分别为43％（12／28）和43％（13／30），两组胃底静脉曲张的基本消失率和缓解率比较差异无统计学意义（X^2=0．026、0．001，均为P〉0．05）。首次治疗后1个月、6个月、12个月累积再出血率差异亦无统计学意义（X^2〈0．001及X^2=0．009、0．043，均为P〉0．05）。2组患者均无发生异位栓塞和穿孔等严重并发症。GVL组和GVO组病死率分别为7％（2／28）和10％（3／30），比较差异无统计学意义（X^2〈0．001，P〉0．05）。结论GVL能安全、有效治疗肝硬化门静脉高压急性胃底静脉曲张出血，疗效与GV0相当。Objective To investigate the efficacy of gastric variceal ligation （GVL） for gastric variceal hemorrhage（GVH）. Methods Fifty-eight patients diagnosed by gastroscope as liver cirrhosis and portal hypertension with acute GVH from July 2008 to March 2012 in the Third Affiliated Hospital of Sun Yat-Sen University were enrolled in the prospective study. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. The patients including 48 males and 10 females were randomized to GVL group （n=28） and gastric variceal obliteration with adhesive （GVO） group （n=30）. The patients were followed up and the 24 h bleeding control, rebleeding rate, gastric variceal （GV） basic disappearance rate, remission rate, complications and death rate were observed andcompared byx2 test. Results The band ligation of GVL group was （3.5±1.4）circles. The injecting dose of tissue adhesive n-butyl-2-cyanoacrylate in the GVO group was 1-3（median 2）ml according to the diameter of varice mass. The injection points were 1- 4 （median 2）. Fifteen and 11 cases with acute active bleeding were observed in the GVL and GVO group respectively. Bleeding control rates in 24 h of both groups were 100%. The total effective rate of two groups were 72%（20/28） and 70%（21/30） respectively. The GV basic disappearance rate were 29%（8/28 ）and 27%（8/30）and the remission rate were 43%（ 12/28）and 43%（ 13/ 30）. There was no differences between two groups in the GV basic disappearance rate and remission rate （ X^2=0.026, 0.001, all in P〉0.05）. There was no differences between two groups in the 1, 6, 12 months accumulated rebleeding rate （X^2〈0.001,X^2=0.009, 0.043, all in P〉0.05）. No complications such as ectopic embolism and perforation were observed in two groups. The death rates of GVL and GVO group were 7% （2/28）and 10%（3/30）. No differences were observed（X^2〈0.001, P〉0.05）. Conclusions GVL is the safe and effective

关 键 词：胃底静脉曲张破裂出血 内镜下治疗 套扎术 组织粘合剂 

分 类 号：R575.2[医药卫生—消化系统]