微创套扎、组织胶注射联合PSE与Hassab术防治食管胃底静脉曲张破裂再出血的疗效观察  

Short-term and long-term efficacy of minimally invasive ligation,tissue adhesive injection combined with partial splenic embolization and conventional pericardial devascularization plus splenectomy in the prevention and treatment of esophagogastric variceal rebleeding

作　　者：孟庆顺 李洪运[1] 杨村 吕鹏[1] 王翔[2] 陈玉[3] MENG Qing-shun;LI Hong-yun;YANG Cun;LYU Peng;WANG Xiang;CHEN Yu(Department of Gastroenterology, First People′s Hospital of Jining, Shandong Province, Jining 272011, China;Department of Rheumatology, Affiliated Hospital of Qingdao University , Shandong Province, Qingdao 266006, China;Department of Pathology and Immunology, Leshan Vocational and Technical College, Sichuan Province, Leshan 614013, China)

机构地区：[1]山东省济宁市第一人民医院消化科,山东济宁272011 [2]青岛大学附属医院风湿科,山东青岛266006 [3]乐山职业技术学院病理免疫教研室,四川乐山614013

出　　处：《河北医科大学学报》2020年第12期1393-1396,1411,共5页Journal of Hebei Medical University

基　　金：国家自然基金面上项目(81870615);山东省医药卫生科技发展计划项目(2017WS826)。

摘　　要：目的探究微创套扎、组织胶注射联合部分性脾动脉栓塞术(partial splenic embolization,PSE)与传统贲门周围血管离断加脾切除术(Hassab术)防治食管胃底静脉曲张破裂再出血的近远期疗效。方法选取86例食管胃底静脉曲张破裂出血患者为研究对象,采用随机数字表法分为微创组及Hassab组,各43例。微创组给予套扎、组织胶注射联合PSE术治疗,Hassab组给予Hassab术治疗。比较两组术前及术后3个月门静脉血流情况(门静脉主干内径、血流速度)、脾功能亢进指标[白细胞(white blood cells,WBC)和血小板(platelet,PLT)]、肝功能(Child-Pugh评分),并记录止血成功及静脉曲张改善效果、术后3个月并发症发生情况、近远期再出血率、术后12个月生存率。结果术后3个月时,两组门静脉主干内径及血流速度均较术前降低(P<0.05),脾功能亢进指标(WBC、PLT)则较术前升高(P<0.05),但组间比较差异无统计学意义(P>0.05);两组Child-Pugh评分较术前降低(P<0.05),而微创组低于Hassab组(P<0.05)。两组止血成功率均为100.00%,两组静脉曲张改善效果、近远期再出血率及术后12个月生存率比较差异无统计学意义(P>0.05)。微创组术后3个月总并发症发生率较Hassab组显著降低(P<0.05)。结论套扎、组织胶注射联合PSE对食管胃底静脉曲张破裂再出血的防控效果与传统Hassab术相当,但创伤较Hassab术更小,对改善患者肝功能有积极意义。Objective To explore the short-term and long-term efficacy of minimally invasive ligation,tissue adhesive injection(TAI)combined with partial splenic embolization(PSE)and traditional pericardial devascularization plus splenectomy(Hassab′s procedure)in the prevention and treatment of esophagogastric variceal rebleeding.Methods Eighty-six patients with esophagogastric variceal bleeding in our hospital were enrolled in the study.The patients were divided into minimally invasive group(n=43)and Hassab group(n=43)according to the random number table method.Minimally invasive group was treated with ligation,TAI combined with PSE,and Hassab group was treated with Hassab′s procedure.The portal vein blood flow(trunk diameter and blood flow velocity of portal vein),hypersplenism indexes[white blood cells(WBC),platelet(PLT)]and liver function(Child-Pugh score)were compared between two groups before surgery and at 3 months after surgery.The success of hemostasis and improvement of varicose veins,occurrence of complications at 3 months after surgery,short-term and long-term rebleeding rates and survival rate at 12 months after surgery were recorded.Results At 3 months after surgery,the trunk diameter and blood flow velocity of portal vein in two groups were decreased compared with those before surgery(P<0.05),while the hypersplenism indexes(WBC,PLT)were increased compared with those before surgery(P<0.05),and there were no significant differences between the groups(P>0.05).The Child-Pugh score in two groups was decreased compared with that before surgery(P<0.05),and the score was lower in minimally invasive group than in Hassab group(P<0.05).The success rates of hemostasis in the two groups were both 100.00%.There were no significant differences in the improvement of varicose veins,short-term and long-term rebleeding rates and survival rate at 12 months after surgery between two groups(P>0.05).The total incidence rate of complications at 3 months after surgery in minimally invasive group was significantly decreased compare

关 键 词：食管和胃静脉曲张 出血 外科手术 微创性 

分 类 号：R571.3[医药卫生—消化系统]