内镜下金属钛夹联合组织胶注射治疗胃静脉曲张的疗效研究  

Efficacy of endoscopic titanium clip combined with cyanoacrylate injection in the treatment of gastric varices

作　　者：席亮 全星璞 王小伟 王云[1] 邱贺 许君望[1] XI Liang;QUAN Xing-pu;WANG Xiao-wei;WANG Yun;QIU He;XU Jun-wang(Department of Gastroenterology,the First Affiliated Hospital of Xi’an Jiaotong University,Shaanxi 710061,China;Department of Gynecologic Neoplasms,Cancer Hospital of Shaanxi Province,Shaanxi 710061,China)

机构地区：[1]西安交通大学第一附属医院消化内科,陕西710061 [2]陕西省肿瘤医院妇瘤科

出　　处：《肝脏》2023年第8期912-915,共4页Chinese Hepatology

摘　　要：目的探讨内镜下金属钛夹联合组织胶注射治疗对GOV1、GOV2、IGV1型胃静脉曲张的临床疗效。方法回顾性分析2017年1月1日-2020年12月31日于西安交通大学第一附属医院住院治疗的150例GOV1、GOV2、IGV1型胃静脉曲张患者。依据治疗方案分为对照组(组织胶治疗,105例)、观察组(钛夹联合组织胶治疗,45例),对比分析两组的临床疗效、再出血率、并发症等。按0、1、3、6个月行随访序贯治疗,共计10个月。结果观察组合并胃/脾肾分流率为22.2%,显著高于对照组0%(P<0.001);观察组胃静脉曲张条数为3(3,3)条,显著高于对照组3(2,3)条(P=0.028);观察组术中平均组织胶用量为(3.29±1.0)mL,显著低于对照组[(4.11±1.51)mL,P=0.020];观察组术后再出血率为11.1%,显著低于对照组(27.6%,P=0.027)。两组内镜治疗次数、组织胶点数、有效率、静脉曲张根除/基本消失率、术后胸骨后疼痛及发热发生率等差异均无统计学意义(P>0.05),两组均未发生菌血症、异位栓塞等严重并发症。结论钛夹联合组织胶注射治疗可减少组织胶用量、降低术后再出血发生率,并可能阻断胃/脾肾分流者异位栓塞的发生,是GOV1、GOV2、IGV1型胃静脉曲张的有效治疗方式。Objective To investigate the clinical efficacy of endoscopic metal titanium clip combined with cyanoacrylate injection on GOV1,GOV2,IGV1 gastric varices.Methods Retrospective analysis of 150 patients with gastric varices of GOV1,GOV2 and IGV1 who were hospitalized in the First Affiliated Hospital of Xi′an Jiaotong University from January 1,2017 to December 31,2020.According to the treatment plan,it was divided into a control group(cyanoacrylate treatment,105 cases)and an observation group(titanium clip combined cyanoacrylate treatment,45 cases).The clinical efficacy,rebleed rate and complications of the two groups were compared and analyzed.Follow-up treatment was performed at 0,1,3,and 6 months,for a total of 10 months.Results The gastric/splenorenal shunt rate in the observation group was 22.2%,which was significantly higher than 0%in the control group(0%)(P<0.001);the number of gastric varices in the observation group was 3(3,3),which was significantly higher than 3(2,3)in the control group(P=0.028);the average cyanoacrylate dosage in the observation group was 3.29±1.0 mL,which was significantly lower than 4.11±1.51 mL in the control group(P=0.020);the rebleeding rate in the observation group was 11.1%,significantly lower than 27.6%in the control group(P=0.027).There was no significant difference between the two groups in the number of endoscopic treatment,injection points of cyanoacrylate,effective rate,varicose eradication/basic disappearance rate,postoperative sternal pain and fever(P>0.05).No serious complications such as bacteremia and ectopic embolism occurred in the two groups.Conclusion Titanium clip combined with cyanoacrylate injection therapy can reduce the amount of tissue glue,reduce the incidence of postoperative rebleeding,and may block the occurrence of ectopic embolism in gastric/spleen-kidney shunts.It is an effective treatment for gastric varices of GOV1,GOV2 and IGV1.

关 键 词：钛夹 组织胶注射 胃/脾肾分流 疗效 异位栓塞 

分 类 号：R573[医药卫生—消化系统]