不同内镜方案对肝硬化合并食管胃底静脉曲张破裂出血患者临床疗效及安全性分析  

Clinical efficacy and safety of different endoscopy methods in patients with liver cirrhosis complicated with esophagogastric varicosity bleeding

作　　者：余中贵[1,2] 林燕华 黄文峰[1] 李丙生[1] YU Zhong-gui;LIN Yan-hua;HUANG Wen-feng(Department of Gastroenterology,The First People's Hospital of Huizhou,Huizhou Guangdong 516001,China;Huizhou Medical Research Institute,Huizhou Guangdong 516001,China)

机构地区：[1]惠州市第一人民医院消化内科,广东惠州516001 [2]惠州市医学研究所,广东惠州516001

出　　处：《临床和实验医学杂志》2018年第8期813-816,共4页Journal of Clinical and Experimental Medicine

基　　金：惠州市科技计划项目(编号:2015Y113)

摘　　要：目的分析不同内镜方案对肝硬化合并食管胃底静脉曲张破裂出血患者临床疗效及安全性的影响。方法回顾性分析2012年10月至2015年10月间在惠州市第一人民医院进行内镜治疗肝硬化食管胃底静脉曲张出血患者248例,其中组织黏合剂注射结合硬化剂治疗患者120例为硬化剂组,套扎手术结合组织黏合剂注射治疗患者128例为套扎组。观察两组患者临床疗效果、手术后病死率、并发症发生率、近期(一个月)出血率和远期(两年)出血率,患者手术前后血氧饱和度、血压及心率改变状况。结果套扎组患者总有效率(88.28%)高于硬化剂组(82.50%),但差异无统计学意义(P>0.05)。套扎组并发症率为2.34%、远期再出血率为8.59%,低于硬化剂组的15.83%、24.17%,差异均有统计学意义(P<0.05)。两组患者手术前后血氧饱和度、血压及心率状况对比,差异均无统计学意义(P>0.05)。结论内镜下套扎手术结合组织黏合剂注射对肝硬化合并食管胃底静脉曲张破裂出血患者治疗效果理想,其远期再出血与并发症发生率低于组织黏合剂注射结合硬化剂治疗,对患者血氧饱和度、血压及心率无明显影响,可作为临床首选止血方法。Objective To analyze the clinical effects and safety of different endoscopic regimens in patients with cirrhosis complicated with esophagogastric variceal bleeding.Methods A retrospective analysis of 248 patients with endoscopic treatment of end-stage liver cirrhosis complicated with esophageal variceal bleeding from October 2012 to October 2015 were performed,including 120 patients treated with tissue adhesive injection and sclerotherapy,128 cases of ligation group were treated with drug injection,ligation and tissue adhesive injection.The curative effect,the postoperative mortality,the incidence of complications,the recent(one month)bleeding rate and the long-term(two years)bleeding rate,oxygen saturation before and after surgery,blood pressure and heart rate changes were investigated and analyzed.Results The total effective rate of ligation group(88.28%)was higher than that of sclerotherapy group(82.50%),but the difference was not statistically significant(P>0.05).The complication rate in ligation group was 2.34%,and the rate of long-term rebleeding was 8.59%,which was lower than 15.83%and 24.17%in sclerostin group(P<0.05).There was no significant difference between the two groups in the blood oxygen saturation,blood pressure and heart rate before and after surgery(P>0.05).Conclusion The results of endoscopic ligation combined with tissue adhesive injection in the treatment of patients with cirrhosis combined with esophageal variceal bleeding satisfactory,the long-term rebleeding and complication rate are lower than the tissue adhesive injection combined with sclerotherapy.It has no significant effect on the patient's blood Oxygen saturation,blood pressure and heart rate,and can be used as the clinical choice of hemostasis method.

关 键 词：肝硬化 食管胃底静脉曲张 出血 内镜下套扎手术 内镜下硬化剂注射 

分 类 号：R575.2[医药卫生—消化系统]