内镜下注射自体富血小板血浆治疗难治性上消化道瘘8例临床分析  

Clinical analysis of 8 cases of refractory upper gastrointestinal fistula treated with endoscopic injection of autologous platelet rich plasma

作　　者：刘嘉浩 李璐蓉 张伟锋[1] 周小玉[2] 夏君君 张国新[1] 王云[1] Liu Jiahao;Li Lurong;Zhang Weifeng;Zhou Xiaoyu;Xia Junjun;Zhang Guoxin;Wang Yun(Department of Gastroenterology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Blood Transfusion,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院消化内科,南京210029 [2]南京医科大学第一附属医院输血科,南京210029

出　　处：《中华消化杂志》2023年第11期741-746,共6页Chinese Journal of Digestion

基　　金：江苏省人民医院临床能力提升工程医疗项目(JSPH-MB-2022-12、JSPH-MB-2021-19、JSPH-MC-2021-21)。

摘　　要：目的评估内镜下注射自体富血小板血浆(PRP)治疗难治性上消化道瘘(RUGF)的安全性和有效性。方法纳入2022年6月1日至2023年3月1日在南京医科大学第一附属医院消化内科接受PRP治疗的8例RUGF患者。记录患者的基线资料如性别、年龄、病程、体重指数等,PRP治疗相关资料如首次治疗时间、首次治疗后住院时间、有无不良事件等。随访至首次治疗后6个月,评估瘘口愈合情况,记录患者体重指数、健康调查简表评分等。统计学方法采用配对t检验和非参数检验。结果8例RUGF患者中,男7例、女1例;中位年龄(范围)为58.5岁(27.0~75.0岁),中位病程(范围)为14个月(4~120个月),瘘口最大径为(4.50±2.62)mm,PRP血小板浓缩倍数为(4.02±0.48)倍。首次内镜下PRP注射治疗时间为(21.88±4.52)min,中位首次治疗后住院时间(范围)为2 d(1~2 d),中位治疗总次数(范围)为4次(1~5次)。瘘口愈合时间为(2.57±1.72)个月,7例RUGF患者在首次治疗后6个月内愈合、1例患者瘘口缩小,术中、术后均无不良事件发生。8例RUGF患者治疗后6个月的体重指数,以及健康调查简表生理机能、生理职能、躯体疼痛、一般健康状况、活力、社会功能、情感职能和精神健康8个维度评分均高于治疗前[(20.91±2.15)kg/m^(2)比(18.67±3.21)kg/m^(2)、(86.88±13.35)分比(58.13±20.34)分、100分(0~100分)比0分(0~100分)、(83.06±11.74)分比(56.94±28.86)分、(67.88±26.77)分比(31.88±13.08)分、(81.88±13.87)分比(46.25±24.02)分、(76.56±22.60)分比(37.50±26.73)分、100分(0~100分)比0分(0~100分)、(78.00±17.37)分比(51.50±22.77)分],差异均有统计学意义(t=-3.40、-3.87,Z=2.06,t=-3.03、-4.26、-4.73、-6.06,Z=-2.06,t=-4.32;P=0.012、0.006、0.039、0.019、0.004、0.002、0.001、0.039、0.003)。结论内镜下注射自体PRP治疗RUGF安全、有效,对较小瘘口(最大径≤6 mm)有明显促进愈合作用。Objective To evaluate the safety and efficacy of endoscopic injection of autologous platelet rich plasma(PRP)in the treatment of refractory upper gastrointestinal fistula(RUGF).Methods From June 1,2022 to March 1,2023,at the Department of Gastroenterology of the First Affiliated Hospital of Nanjing Medical University,8 RUGF patients who received PRP treatment were enrolled.The baseline data such as gender,age,course of disease,and body mass index,etc.as well as the PRP treatment-related data such as the time of first treatment,length of hospital stay after the first treatment,and adverse events were recorded.The postoperative follow-up lasted till 6 months after the first treatment to assess fistula healing,and to record body mass index and health survey short form.Paired t-test and non-parametric test were used for statistical analysis.Results Among the 8 RUGF patients,there were 7 males and 1 female.The median age was 58.5 years old(ranged from^(2)7.0 to 75.0 years old),and the median duration of the disease was 14 months(ranged from 4 to 120 months).The maximum diameter of the fistula was(4.50±2.62)mm,the concentration multiple of PRP was(4.02±0.48)times.The operation time of the first endoscopic PRP treatment was(21.88±4.52)min;the median length of the first postoperative hospital stay was 2 days(ranged from 1 to 2 days),and the median total number of treatment was 4(ranged from 1 to 5).The healing time was(2.57±1.72)months,7 RUGF patients healed within 6 months after the first treatment,and the fistula was narrowed in 1 patient.There were no adverse events during or after the operation.After 6 months of treatment,the body mass index and the scores of 8 dimensions of the health survey short form which included physical functioning,physical role functioning,body pain,general health,vitality,social functioning,emotional role functioning and mental health were all higher than those before treatment((20.91±2.15)kg/m^(2) vs.(18.67±3.21)kg/m^(2),86.88±13.35 vs.58.13±20.34,100(0 to 100)vs.0(0 to 100),83.06±

关 键 词：富血小板血浆 难治性上消化道瘘 生长因子 内镜治疗 

分 类 号：R57[医药卫生—消化系统]