内镜下金属夹辅助静脉曲张套扎术治疗胃静脉曲张疗效分析  

Efficacy of metal clip assisted endoscopic variceal ligation on gastric varices

作　　者：李佳鑫 全润钊 王艺 张昊 李贞娟 徐闪闪 卢曼曼 丁辉 曹名波 李修岭 LI Jiaxin;QUAN Runzhao;WANG Yi;ZHANG Hao;LI Zhenjuan;XU Shanshan;LU Manman;DING Hui;CAO Mingbo;LI Xiuling(Department of Gastroenterology,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]郑州大学人民医院,河南省人民医院消化内科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2024年第2期156-159,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划省部共建项目(SBGJ202102039)。

摘　　要：目的比较内镜下金属夹辅助静脉曲张套扎术(MEVL)与内镜下组织胶注射术(ETAI)治疗胃静脉曲张(GV)的效果及安全性。方法2017年1月—2023年3月河南省人民医院诊治肝硬化伴食管胃静脉曲张出血患者82例,根据治疗方式分为MEVL组44例和ETAI组38例,比较2组病因、Child-Pugh评分、MELD评分、腹腔积液、门静脉血栓、肝性脑病、食管胃静脉曲张分型、食管静脉曲张(EV)严重程度、GV直径、实验室指标等;比较2组GV金属夹数量、GV套扎环数、GV组织胶用量、EV套扎环数、内镜治疗时间、住院时间、内镜治疗成功率;记录2组术后发热、胸痛、恶心呕吐、脱环、异位栓塞、排胶溃疡、再出血及死亡等不良事件发生情况。结果2组病因、Child-Pugh评分、MELD评分、腹腔积液、门静脉血栓、肝性脑病、食管胃静脉曲张分型、EV严重程度、GV直径、血红蛋白、血小板计数、国际标准化比值、凝血酶原时间、总胆红素、白蛋白、血肌酐比较差异均无统计学意义(P>0.05)。MEVL组GV金属夹数量为3(2,4)个,GV套扎环数为4(3,7)环,ETAI组GV组织胶用量为3.3(2.0,4.5)mL;MEVL组EV套扎环数[8(5,12)环]、内镜治疗时间[27(21,34)min]、住院时间[10(7,13)d]、内镜治疗成功率(100.0%)与ETAI组[7(6,10)环、25(21,45)min、13(9,15)d、94.7%]比较差异均无统计学意义(P>0.05)。MEVL组术后发生再出血5例,死亡5例;ETAI组术后发生异位栓塞1例,排胶溃疡22例,再出血17例,死亡3例;MEVL组恶心呕吐、再出血发生率(2.3%、11.4%)均低于ETAI组(15.8%、44.7%)(P=0.045;χ^(2)=11.568,P=0.001),发热、胸痛发生率及病死率与ETAI组比较差异均无统计学意义(P>0.05)。结论食管胃静脉曲张患者GV采用MEVL治疗成功率高,术后恶心呕吐、再出血发生率较ETAI低。Objective To compare the efficacy and safety of metal clip assisted endoscopic variceal ligation(MEVL)versus endoscopic tissue adhesive injection(ETAI)in the treatment of the gastric varices(GV).Methods Eighty-two cirrhotic patients with gastroesophageal variceal bleeding in Henan Provincial People's Hospital from January 2017 to March 2023 were divided into MEVL group(n=44)and ETAI group(n=38),and were compared the etiology,Child-Pugh score,MELD score,ascites,portal vein thrombosis,hepatic encephalopathy,gastroesophageal variceal classification,severity of esophageal varices(EV),diameter of GV and laboratory indexes between two groups.The number of GV metal clips,number of GV ligating bands,amount of GV tissue adhesive agent,number of EV ligating bands,duration of endoscopic treatment,length of hospital stay and success rate of endoscopic treatment were compared between two groups.The adverse events such as fever,chest pain,nausea/vomiting,off-band,ectopic embolism,glue cast extrusion ulceration,rebleeding and death were recorded in two groups.Results There were no significant differences in the etiology,Child-Pugh score,MELD score,ascites,portal vein thrombosis,hepatic encephalopathy,gastroesophageal variceal classification,severity of EV,diameter of GV,hemoglobin,platelet count,international standard ratio,prothrombin time,total bilirubin,albumin and serum creatinine between two groups(P>0.05).MEVL group used 3(2,4)GV metal clips and 4(3,7)GV ligating bands,and ETAI group used 3.3(2.0,4.5)mL GV tissue adhesive agent.There were no significant differences in the number of EV ligating bands[8(5,12)vs.7(6,10)],the duration of endoscopic treatment[27(21,34)min vs.25(21,45)min],the length of hospital stay[10(7,13)d vs.13(9,15)d]and the success rate of endoscopic treatment(100.0%vs.94.7%)between MEVL group and ETAI group(P>0.05).In MEVL group,there were 5 cases of rebleeding and 5 cases of death.In ETAI group,there were 22 cases of glue cast extrusion ulcer,17 cases of rebleeding and 3 cases of death.The incidence ra

关 键 词：胃静脉曲张 内镜下金属夹辅助静脉曲张套扎术 内镜下组织胶注射术 再出血 

分 类 号：R657.31[医药卫生—外科学]