内镜下钛铗联合组织胶治疗中重度胃底静脉曲张的临床效果  

Clinical efficacy of endoscopic titanium clips combined with tissue glue in treatment of moderate-to-severe gastric fundus varices

作　　者：朱元东 施言 谢欣城[1] 周丹[1] 李晓 金指望 朱群 吴乾能 章復龙[1] 方蕾 陈玲玲[1] Zhu Yuandong;Shi Yan;Xie Xincheng;Zhou Dan;Li Xiao;Jin Zhiwang;Zhu Qun;Wu Qianneng;Zhang Fulong;Fang Lei;Chen Lingling(Department of Gastroenterology,Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310023,China)

机构地区：[1]浙江中医药大学附属杭州市西溪医院消化内科

出　　处：《中华临床医师杂志（电子版）》2019年第10期731-735,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：2016年杭州市科技计划引导项目(农业与社会发展)(20163501Y23);2017年杭州市社会发展自主申报项目(医疗卫生领域)(20170533B80)

摘　　要：目的研究内镜下钛铗联合组织胶治疗中重度胃底静脉曲张的临床价值。方法回顾性分析2013年2月1日至2017年7月31日期间,因上消化道出血,经杭州市西溪医院内镜下组织胶治疗的中重度胃底静脉曲张患者60例,分为单纯组(采用聚桂醇组织胶聚桂醇注射治疗)和联合组(采用钛铗联合聚桂醇组织胶聚桂醇注射治疗)各30例;采用χ2检验比较2组患者内镜治疗后1年内再出血率、病死率和异位栓塞的发生率,采用t检验比较2组患者再出血发生的时间、每例中重度胃底静脉曲张患者组织胶治疗的用量。结果与单纯组比较,联合组每例中重度胃底静脉曲张患者组织胶治疗的用量减少[(1.73±1.01)ml vs(1.13±0.64)ml],差异具有统计学意义(t=-2.736,P=0.008)。联合组与单纯组治疗后1、3、6、9、12个月的再出血率[联合组:3.3%(1/30)、10.0%(3/30)、23.3%(7/30)、33.3%(10/30)、36.7%(11/30);单纯组:13.3%(4/30)、26.7%(8/30)、36.7%(11/30)、50.0%(15/30)、53.3%(16/30)]、再出血时间[(5.69±3.28)min vs(4.59±3.49)min]、病死率(1/30 vs 4/30)比较,差异均无统计学意义(P>0.05)。2组患者临床均未见异位栓塞发生。结论内镜下钛铗联合组织胶治疗可以减少中重度胃底静脉曲张患者组织胶的用量,再出血时间、再出血率、再出血相关的病死率以及异位栓塞的发生率等未见增加,因此,内镜下钛铗联合组织胶治疗是一种安全、有效的治疗方法。Objective To evaluate the clinical efficacy of endoscopic titanium clips combined with tissue glue in the treatment of moderate-to-severe gastric fundus varices.Methods A retrospective analysis was conducted on 60 patients with moderate-to-severe gastric varices treated with endoscopic tissue glue for upper gastrointestinal bleeding at Hangzhou Xixi Hospital from February 1,2013 to July 31,2017.The patients were divided into either a monotherapy group(treatment with Polyguiol-Tissue Gum-Polyguiol)or a combination therapy group(treatment by Titanium clipcombined with Polyguiol-Tissue Gum-Polyguiol)with 30 cases each.The Chi-square test was used to compare the rate of recurrent bleeding,mortality,and incidence of ectopic embolism within 1 year after endoscopic treatment in the two groups,and the t-test was used to compare the time of recurrent bleeding in the two groups and the amount of tissue glue used.Results Compared with the monotherapy group,the amount of tissue glue used in the combination therapy group was significantly reduced[(1.73±1.01)ml vs(1.13±0.64)ml],t=-2.736,(P=0.008).There was no significant difference between the combination therapy group and the monotherapy group in the rebleeding rates at 1,3,6,9,and 12 months after treatment[3.3%(1/30)vs 13.3%(4/30);10.0%(3/30)vs 26.7%(8/30);23.3%(7/30)vs 36.7%(11/30);33.3%(10/30)vs 50.0%(15/30);36.7%(11/30)vs 53.3%(16/30)],rebleeding time[(5.69±3.28)min vs(4.59±3.49)min],or mortality(1/30 vs 4/30)(P>0.05 for all).Ectopic embolism was not found in either group.Conclusion Endoscopic tissue glue combined with titanium clips can reduce the amount of tissue glue used in patients with moderate-to-severe gastric varices.The time of rebleeding,rebleeding rate,rebleeding-related mortality,and the incidence of ectopic embolism do not increase in the combination therapy group.Therefore,endoscopic titanium clips combined with tissue glue therapy are a safe and effective method.

关 键 词：静脉曲张 胃底 组织胶 钛铗 再出血 异位栓塞 

分 类 号：R575.2[医药卫生—消化系统]