卡维地络联合内镜下精准食管胃静脉曲张断流术治疗食管胃静脉曲张破裂出血的疗效  

A study on the applycation of carvedilol combined with endoscopic selective varices devascularization in the treatment for esophageal and gastric varices bleeding

作　　者：黎美琳 姚上志 王栋 居峰 王晓伟 LI Mei-lin;YAO Shang-zhi;WANG Dong;JU Feng;WANG Xiao-wei(Department of Gastroenterology,Wuxi No.5 People’s Hospital,Jiangsu 214000,China)

机构地区：[1]无锡市第五人民医院消化内科,江苏214000

出　　处：《肝脏》2021年第9期980-983,共4页Chinese Hepatology

摘　　要：目的评估口服卡维地络联合内镜下精准食管胃静脉曲张断流术治疗食管胃静脉曲张出血患者的有效性及安全性。方法回顾性研究40例肝硬化伴食管胃静脉曲张出血患者,按治疗方法纳入内镜下精准食管胃静脉曲张断流术(ESVD)组22例,卡维地络联合ESVD组18例,重点比较两组再出血率、死亡率、内镜下改善率及并发症发生情况。结果术后2周内ESVD组和联合组再出血率分别为36.4%(8/22)、11.1%(2/18),两组间差异无统计学意义(P>0.05);而术后6月内联合组再出血率为22.2%(4/18),明显优于ESVD组54.5%(12/22),差异有统计学意义(P<0.05)。6月内两组出血相关死亡率分别为9.1%(1/22)、5.6%(1/18),总体死亡率分别为9.1%(1/22)、5.6%(1/18),差异均无统计学意义(P>0.05)。ESVD组和联合组术后1个月内镜下改善率分别为59.1%(13/22)、88.8%(16/18),术后6月分别为54.5%(12/22)、88.8%(16/18),差异均有统计学意义(P<0.05)。ESVD组和联合组随访期间无严重并发症发生。结论内镜下精准食管胃静脉曲张断流术联合卡维地络在食管胃静脉曲张出血患者中应用疗效较好、安全性高,值得临床推广。Objective To evaluate the clinical efficacy and safety of endoscopic selective varices devascularization(ESVD)combined with oral carvedilol in the treatment for patients with esophageal and gastric varices bleeding(EGVB).Methods A retrospective analysis was performed on 40 cirrhosis patients with EGVB.According to different methods of treatment,22 patients were selected into ESVD group,and 18 patients were selected into carvedilol combined ESVD group,respectively.The rate of rebleeding,mortality,endoscopic improvement rate and the incidence of complications were compared between two groups.Results The rebleeding rates within 2 weeks after treatment of ESVD group and combined treatment group were 36.4%(8/22)and 11.1%(2/18),respectively,which was no significant difference(P>0.05).The rebleeding rate within 6 months after treatment of combined treatment group was 22.2%(4/18),which was significantly lower than that of ESVD group(54.5%,12/22)(P<0.05).The rates of hemorrhage-related death within 6 months after surgery in ESVD group and combined treatment group were 9.1%(1/22)and 5.6%(1/18),respectively,and the overall mortality were 9.1%(1/22)and 5.6%(1/18),respectively,which was no statistically significant(P>0.05).One month after treatment,endoscopic improvement rates of ESVD group and combined treatment group were 59.1%(13/22)and 88.8%(16/18)respectively,which was statistically significant(P<0.05).Six months after treatment,endoscopic improvement rates of ESVD group and combined treatment group were 54.5%(12/22)and 88.8%(16/18)respectively,which was statistically significant(P<0.05).No serious complication occurred in both groups during the follow-up period.Conclusion The efficacy and safety of ESVD combined with oral carvedilol are more available in the treatment for patients with EGVB,which is worthy clinical promotion.

关 键 词：肝硬化 食管胃静脉曲张破裂出血 内镜下精准食管胃静脉曲张断流术 卡维地络 

分 类 号：R65[医药卫生—外科学]