内镜下治疗对肝硬化伴EGV患者疗效、出血情况、胃黏膜因子及血氨的影响  

Effects of endoscopic treatment on the efficacy,bleeding,gastric mucosal factors and blood ammonia in patients with cirrhosis and EGV

作　　者：杨中菊 查正伟[1] 彭琼[1] YANG Zhong-ju;ZHA Zheng-wei;PENG Qiong(Department of Gastroenterology,First People's Hospital of Hefei,Hefei 230061,Anhui,China)

机构地区：[1]合肥市第一人民医院消化内科,合肥安徽230061

出　　处：《川北医学院学报》2021年第5期655-658,共4页Journal of North Sichuan Medical College

摘　　要：目的:探讨内镜下治疗对肝硬化伴食管胃底静脉曲张(EGV)患者疗效、出血情况、胃黏膜因子及血氨的影响。方法:将76例肝硬化伴EGV患者按照治疗方式不同分为观察组和对照组,每组各38例。对照组患者予以奥美拉唑、奥曲肽等常规治疗,观察组在其基础上,给予内镜下治疗,包括内镜下套扎(EVL)、内镜下注射硬化剂(EVS)及胃底组织胶注射术。比较两组患者临床疗效、出血情况(止血成功率、再出血发生率、死亡率)、胃泌素-17(GAS-17)、胃蛋白酶原Ⅰ、胃蛋白酶原Ⅱ、血氨水平及不良反应发生情况。结果:观察组治疗的总有效率高于对照组(94.74%vs.71.05%,P<0.05)。治疗3个月后,两组患者死亡率比较,差异无统计学意义(P>0.05)。观察组止血成功率高于对照组(P<0.05),治疗1~3个月后再出血发生率低于对照组(P<0.05)。治疗后,两组患者GAS-17、胃蛋白酶原Ⅰ、胃蛋白酶原Ⅱ、血氨水平均降低(P<0.05),且观察组低于对照组(P<0.05)。两组患者不良反应率比较,差异无统计学意义(P>0.05)。结论:与传统保守治疗相比,内镜下治疗更能提升肝硬化并EGV出血患者的治疗效果,降低其再出血风险,改善其胃肠激素水平及血氨水平,且不增加不良反应的发生风险,具有临床推广意义。Objective:To investigate the effect of endoscopic treatment on the efficacy,bleeding,gastric mucosal factors and blood ammonia in patients with liver cirrhosis and esophageal varices(EGV).Methods:A total of 76 patients with liver cirrhosis with EGV were divided into observation group(n=38)and control group(n=38)according to different treatment methods.Patients in the control group received routine treatment such as omeprazole and octreotide,and patients in the observation group were treated with endoscopic variceal ligation(EVL),endoscopic variceal sclerosisis(EVS)and injection of gastric fundus tissue glue on the basis of omeprazole and octreotide.The clinical efficacy,bleeding(hemostasis success rate,rebleeding rate and mortality rate),gastrin-17(GAS-17),pepsinogen Ⅰ,pepsinogen Ⅱ,blood ammonia and adverse reactions were observed and compared between the two groups.Results:After treatment,the total clinical effective rate of the observation group(94.74%)was significantly higher than that of the control group(71.05%,P<0.05).After 3 months of treatment,there was no significant difference in mortality between the two groups(P>0.05).The rate of successful hemostasis in the observation group was significantly higher than that in the control group(P<0.05),and the incidence of rebleeding after treatment(1-3 months)was significantly lower than that in the control group(P<0.05).The levels of GAS-17,pepsinogen Ⅰ,pepsinogen Ⅱ and blood ammonia in the two groups were significantly lower than those before treatment(P<0.05),and the observation group was lower than the control group(P<0.05).There was no significant difference in the rate of ADR between the two groups(P>0.05).Conclusion::Compared with traditional conservative treatment,endoscopic treatment can better improve the treatment effect of patients with liver cirrhosis and esophageal and gastric varices bleeding,reduce the risk of rebleeding,improve the level of gastrointestinal hormones and blood ammonia,and do not increase the risk of adverse reactions,which

关 键 词：肝硬化 食管胃底静脉曲张 内镜下套扎 内镜注射硬化剂 胃底组织胶注射术 疗效 出血情况 胃黏膜因子 血氨 

分 类 号：R571.3[医药卫生—消化系统]