内镜下套扎术联合组织胶黏合剂治疗食管胃底静脉曲张的效果及治疗后早期再出血影响因素  

Effect of endoscopic ligation operation combined with tissue adhesive a-gent in the treatment of esophageal gastric varices and the influence fac-tors of early rebleeding after treatment

作　　者：李应杰 

机构地区：[1]郑州市中医院内镜室,河南郑州450007

出　　处：《中国医药导报》2016年第22期65-68,共4页China Medical Herald

摘　　要：目的分析内镜下套扎术联合组织胶黏合剂治疗食管胃底静脉曲张的效果及治疗后早期再出血影响因素。方法选择2012年1月~2015年12月郑州市中医院收治的食管胃底静脉曲张110例患者为研究对象,所有患者均采用内镜下套扎术联合织胶黏合剂治疗。观察患者的近期治疗效果及早期再出血发生率;分析患者早期再出血的影响因素。结果经过手术,110例患者均成功止血,治疗后4 d^6个月,31例患者发生早期再出血。单因素分析结果显示,有效止血患者性别、年龄、病因、谷丙转氨酶、总胆红素、血清白蛋白水平与再出血患者比较,差异均无统计学意义(P>0.05);而Child-Pugh分级、谷草转氨酶、腹水、曲张静脉内径、静脉曲张血管数量、红色征、脾栓或脾切除术与再出血患者比较,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,Child-Pugh分级C级(OR=2.564,95%CI:1.289~2.957,P=0.034)、腹水(OR=2.496,95%CI:1.852~2.677,P=0.029)、曲张静脉内径(OR=3.450,95%CI:2.639~3.991,P=0.015)、静脉曲张血管数量>2支(OR=2.131,95%CI:2.055~3.843,P=0.018)、红色征(OR=4.015,95%CI:3.587~4.982,P=0.009)、脾栓或脾切除术(OR=4.622,95%CI:3.457~4.905,P=0.004)均为食管胃底静脉曲张患者治疗后早期再出血的危险因素。结论内镜下套扎术联合组织胶黏合剂可有效治疗食管胃底静脉曲张,然而治疗后早期易发生再出血,Child-Pugh分级C级、腹水、曲张静脉内径、静脉曲张血管数量、红色征及脾栓或脾切除术均是其危险因素。Objective To analyze the effect of endoscopic ligation operation combined with tissue adhesive agent in the treatment of esophageal gastric varices and the influence factors of early rebleeding after treatment. Methods From January 2012 to December 2015, 110 cases of patients with esophageal gastric varices in Hospital of Traditional Chinese Medicine of Zhengzhou City were selected as the research objects. All patients were treated by endoscopic ligation operation combined with tissue adhesive agent. Treatment effect and the incidence of early rebleeding were observed, and the influence factors of early rebleeding were analyzed. Results After surgery, 110 patients were all successful hemostasis. 4 d-6 months after treatment, 31 patients occurred early rebleeding. Single factor analysis results showed that, gender, age, pathogenesis, ALT, total bilirubin, serum albumin between patients with effective hemostatic and rebleeding had no statistically significant differences （P 〉 0.05）; and Child-Pugh grading, AST, ascites, varicose vein diameter, number of varicose veins blood vessels, the red sign, spleen or splenectomy of patients with hemorrhage and rebleeding had statistically significant differences （P 〈 0.05）. Logistic regression analysis results showed that, the Child- Pugh class C （OR = 2.564, 95%CI： 1.289-2.957, P = 0.034）, ascites （OR = 2.496, 95%CI： 1.852-2.677, P = 0.029）, varicose vein diameter （OR = 3.450, 95%CI： 2.639-3.991, P = 0.015）, number of varicose veins blood vessels more than two （OR = 2.131, 95%CI： 2.055-3.843, P = 0.018）, red sign （OR = 4.015, 95%CI： 3.587-4.982, P = 0.009）, spleen or splenectomy （OR = 4.622, 95%CI： 3.457-4.905, P = 0.004） were risk factors of early rebleeding of patients with esophageal gastric varices after the treatment of endoscopic ligation operation combined with tissue adhesive agent. Conclusion Eendoscopic ligation operation combined with tissue adhesive agent is effective in the treatment of esophageal gastric varices,

关 键 词：食管胃底静脉曲张 内镜 套扎术 组织胶 再出血 危险因素 

分 类 号：R571.3[医药卫生—消化系统]