“改良三明治夹心法”行ESVD术治疗肝硬化并发食管胃静脉曲张患者疗效研究  

Modified sandwich endoscopic selective varices devascularization in the treatment of cirrhotics with esophagogastric varices

作　　者：姜亚超 尹力 颜状 Jiang Yachao;Yin Li;Yan Zhuang(Department of General Surgery,Shuyang Hospital Affiliated to Nanjing University of Traditional Chinese Medicine,Suqian 223800,Jiangsu Province,China)

机构地区：[1]南京中医药大学沭阳附属医院普外科,江苏省宿迁市223600

出　　处：《实用肝脏病杂志》2023年第6期863-866,共4页Journal of Practical Hepatology

基　　金：江苏省中医药科技发展计划项目(编号:YB2020015)。

摘　　要：目的探讨采用“改良三明治夹心法”行内镜下选择性曲张静脉断流术(ESVD)治疗肝硬化并发食管胃静脉曲张(EGV)的疗效。方法2018年1月~2022年12月我院收治的肝硬化并发EGV患者106例,采用随机数字表法将患者分为观察组53例和对照组53例,给予所有患者护肝、降低门脉压和病因治疗,另在观察组采用“改良三明治夹心法”行ESVD术治疗。在治疗后3个月行胃镜复查,评估疗效,并随访1年,观察食管胃底静脉曲张破裂出血(EGVB)情况。结果术后,观察组5例(9.4%)存在曲张静脉未消除,行二次手术治疗;在治疗3个月后复查胃镜,发现观察组曲张静脉消失或减轻总有效率为84.9%;两组血清白蛋白水平均显著上升,观察组血清总胆红素、白蛋白和凝血酶原时间分别为(16.2±1.4)μmol/L、(33.3±1.9)g/L和(11.3±0.4)s,与对照组【分别为(16.3±1.5)μmol/L、(33.4±1.8)g/L和(11.2±0.4)s】比,无显著性差异(P>0.05);观察组出现发热3例(5.7%)、胸骨后疼痛3例(5.7%)、腹痛1例(1.9%)、自发性细菌性腹膜炎(SBP)2例(3.8%)、食管溃疡5例(9.4%);随访一年,观察组出现EGVB者5例(9.4%),而对照组出现EGVB者17例(32.1%),两组差异显著(x 2=5.079,P<0.05)。结论采用“改良三明治夹心法”行ESVD术治疗肝硬化并发EGV患者可获得较好的治疗效果,能消除静脉曲张,防止出血。Objective The aim of this study was to investigate the modified sandwich endoscopic selective varices devascularization(ESVD)in the treatment of cirrhotics with esophagogastric varices(EGV).Methods A total of 106 patients with liver cirrhosis and EGV were encountered in our hospital between January 2018 and December 2022,and were randomly divided into observation and control group,with 53 cases in each group.All patients in the two groups were treated with anti-viral,non-selectiveβreceptor blockers and supporting therapy,and those in the observation were given modified sandwich ESVD for sclerotherapy to remove EGV.The gastroscopy was conducted three months after for evaluation of the efficacy,and all patients were followed-up for one year.Results After endoscopic sclerotherapy,5 patients(9.4%)in the observation group had non-disappearance of EGV,which disappeared after second operation;three months after sclerotherapy,the gastroscopy found the disappeared or decreased rate of EGV was 84.9%;serum albumin levels in the two groups increased greatly,and serum bilirubin,albumin and prothrombin time in the observation group were(16.2±1.4)μmol/L,(33.3±1.9)g/L and(11.3±0.4)s,not significantly different as compared to[(16.3±1.5)μmol/L,(33.4±1.8)g/L and(11.2±0.4)s,P>0.05]in the control;the post-operational complications included fever in 3 cases(5.7%),retrosternal pain in 3 cases(5.7%),abdominal pain in 1 case(1.9%),spontaneous bacterial peritonitis in 2 cases(3.8%)and esophageal ulcer in 5 cases(9.4%);at the end of one-year follow-up,the EGV bleeding(EGVB)occurred in 5 cases(9.4%)in the observation group,while it happened in 17 cases(32.1%)in the control,significantly different between the two groups(x 2=5.079,P<0.05).Conclusion The modified sandwich ESVD could achieve a promising efficacy in dealing with patients with liver cirrhosis and EGV,which might eliminate the EGV and prevent EGVB.

关 键 词：肝硬化 食管胃静脉曲张 内镜下选择性曲张静脉断流术 曲张静脉硬化治疗 

分 类 号：R575.2[医药卫生—消化系统]