内镜下治疗食管和胃静脉曲张出血的疗效及门静脉血流动力学改变的临床研究  

Observation of endoscopic treatment of esophageal and gastric variceal bleeding and portal vein hemodynamics changes

作　　者：蒋波涛[1] 徐丽[2] 李荣华[1] 晏喻婷 李桂红[1] 周州[1] 王英[1] 陶杨[1] 

机构地区：[1]广州中医药大学附属重庆北碚中医院消化科,400711 [2]广州中医药大学附属重庆北碚中医院超声影像科,400711

出　　处：《中华消化病与影像杂志（电子版）》2015年第2期23-27,共5页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

摘　　要：目的评价内镜下食管静脉曲张套扎、内镜下食管静脉曲张硬化剂注射、胃底静脉曲张组织黏合剂注射的临床疗效和上述三种方法治疗对门静脉血流动力学的影响。方法采用随机分组法对107例食管胃静脉曲张患者分别进行内镜下注射硬化剂(45例)、组织黏合剂(29例)与内镜下食管静脉曲张套扎(33例)三种治疗方法,术后随访止血率、再出血发生率、曲张静脉曲张消失率、并发症发生率等指标,并采用彩色多普勒超声对三组治疗前后门静脉及其属支的血流动力学指标:门静脉、脾静脉、胃左静脉及肠系膜上静脉的管径、血流速度、血流量进行对比分析。结果三组患者的急诊止血率、术后并发症发生率比较,差异无统计学意义;套扎组曲张静脉消失率(90.9%)高于硬化剂组(71.1%)和组织黏合剂组(65.5%),差异有统计学意义(P<0.05);组织黏合剂组近期及远期再出血率(27.6%、34.5%)高于硬化剂组(15.6%、17.8%)和套扎组(12.1%、18.2%),差异具有统计学意义(P<0.05)。治疗后套扎组和硬化剂组门静脉血管内径均较治疗前有所减小,脾静脉血管内径均增加,但前后对比差异无统计学意义;套扎组门静脉、脾静脉的平均血流速度(22.1±3.0 vs.28.9±5.3、23.5±4.1 vs.31.2±3.9)(mm/s)与血流量(19.8±3.7 vs.26.6±5.1、15.3±3.7 vs.20.9±5.2)(ml/s)、硬化剂组门静脉、脾静脉的平均血流速度(20.9±2.6 vs.26.8±2.4、21.2±4.6 vs.28.7±4.1)(mm/s)与血流量(19.7±3.4 vs.25.8±3.8、18.8±3.1 vs.24.7±2.1)(ml/s)均较治疗前显著增加(P<0.05),胃左静脉和肠系膜静脉的血管内径,平均血流速度与血流量变化不大。组织黏合剂组:治疗后门静脉、脾静脉、胃左静脉内径均增大,但治疗前后比较差异无统计学意义。其平均血流速度、血流量均较治疗前无明显增加,肠系膜静脉的血管内径、平均血流速度、血流量均无显著性变化。结论食管胃静脉曲张内镜下治Objective To evaluate the clinical effect of endoscopic ligation of esophageal varices , endoscopic variceal sclerotherapy,gastric varices tissue adhesive injection and the effects of three methods in the treatment of portal vein hemodynamics.Methods One hundred and seven cases of esophageal and gastric varices were randomly treated with endoscopic injection sclerotherapy（45 cases）,tissue adhesive（29 cases ） and endoscopic variceal ligation （ 33 cases ） .The hemostatic rate, rebleeding rate, varicose vein disappearance rate,complication rate and other indicators were followed up.The hemodynamic indexes of the three groups before and after treatment were measured with color Doppler ultrasound, including pipe diameter,blood flow velocity and blood flow of portal vein, splenic vein, left gastric vein and superior mesenteric vein.Results There was no significant difference of emergency hemostasis rate and complication rate among the three groups.The varicose vein disappearance rate in ligation group（90.9%） was the higher than that in sclerotherapy group （ 71.1%） and tissue adhesive group （ 65.5%） , and the difference was significant（ P〈0.05 ） .The short-term and long-term rebleeding rate in tissue adhesive group （ 27.6%, 34.5%） were higher than those in sclerotherapy group （ 15.6%,17.8%） and ligation group （ 12.1 %,＆amp;nbsp;18.2%）,with significant differences（P〈0.05）.The portal vein diameters decreased and the splenic vein diameters increased in ligation group and sclerotherapy group after treatment, but there was no significant difference before and after treatment.The average blood flow velocity and blood flow of portal vein and splenic vein in ligation group（22.1 ±3.0 vs.28.9 ±5.3,23.5 ±4.1 vs.31.2 ±3.9,19.8 ±3.7 vs.26.6 ±5.1, 15.3 ±3.7 vs.20.9 ±5.2）and sclerotherapy group（20.9 ±2.6 vs.26.8 ±2.4,21.2 ±4.6 vs.28.7 ±4.1, 19.7 ±3.4 vs.25.8 ±3.8,18.8 ±3.1 vs.24.7 ±2.1） after treatment significantly increased （P〈0.05） ,and the diameter,mea

关 键 词：食管和胃静脉曲张 组织黏合剂 硬化疗法 血流动力学 胃镜外科手术 

分 类 号：R575.2[医药卫生—消化系统]