超声内镜引导下置入弹簧圈联合组织胶注射治疗合并自发性分流的胃静脉曲张的效果分析  

Efficacy of endoscopic ultrasound-guided coil placement combined with tissue adhesive injection in treatment of gastric varices with spontaneous shunt

作　　者：汤雅芬 蒋智洋 龙丹 陈金敏 高山 TANG Yafen;JIANG Zhiyang;LONG Dan;CHEN Jinmin;GAO Shan(School of Medicine,Wuhan University of Science and Technology,Wuhan 430065,China;Department of Gastroenterology,The Affiliated Hospital of Hubei University of Arts and Science,Xiangyang Central Hospital,Xiangyang,Hubei 441021,China)

机构地区：[1]武汉科技大学医学院,武汉430065 [2]湖北文理学院附属医院,襄阳市中心医院消化内科,湖北襄阳441021

出　　处：《临床肝胆病杂志》2024年第4期739-744,共6页Journal of Clinical Hepatology

基　　金：湖北省卫生健康委科技项目(WJ2021F066)。

摘　　要：目的评估超声内镜(EUS)引导下置入弹簧圈联合组织胶注射(ECI)治疗合并自发性分流的胃静脉曲张的有效性、安全性和经济性。方法回顾性分析2019年3月—2022年9月因急性胃静脉曲张出血合并自发性门体分流在襄阳市中心医院住院并接受改良球囊封堵逆行静脉闭塞术(BRTO)联合内镜下ECI或EUS引导下置入弹簧圈联合ECI治疗的患者。统计分析两种手术方式的疗效(技术成功率,5天、1年再出血率,再出血时间)、安全性(异位栓塞发生率、组织胶用量、聚桂醇用量)和经济性(住院费用和时间)差异。符合正态分布的计量资料两组间比较采用成组t检验,不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验。采用Kaplan-Meier法对再出血情况进行评估和比较。计数资料两组间比较采用χ2检验。结果25例患者在EUS引导下成功放置弹簧圈并注射组织胶,技术成功率100%,中位组织胶用量为2.5 mL,中位聚桂醇用量为11.0 mL,平均住院时间为(14.88±3.21)d,平均住院费用为(32660.00±4602.07)元,5天再出血率为0;2例失访,23例完整随访患者中住院期间异位栓塞发生率为0,中位再出血时间为689 d。14例患者接受改良BRTO联合内镜下ECI,技术成功率100%,术中中位组织胶用量为5.0 mL,高于EUS组(U=39.000,P<0.001),中位聚桂醇用量为10.5 mL;平均住院时间为(15.38±4.94)d;平均住院费用为(57583.47±18955.40)元,高于EUS组(t=−6.310,P<0.001);5天再出血率为0;无失访,14例完整随访患者中住院期间异位栓塞发生率为0,中位再出血时间为244.50 d。Kaplan-Meier生存曲线分析表明,2组患者再出血风险无明显差异(χ^(2)=1.448,P=0.229)。结论EUS引导置入弹簧圈联合ECI是一种相对安全有效的胃静脉曲张出血治疗技术,技术成功率高,严重不良事件发生率低,疗效与BRTO手术无明显差异,但安全性和经济性更高。Objective To investigate the efficacy,safety,and cost-effectiveness of endoscopic ultrasound(EUS)-guided coil placement combined with tissue adhesive injection in the treatment of gastric varices with spontaneous shunt.Methods A retrospective analysis was performed for the patients with acute gastric variceal bleeding and spontaneous portosystemic shunt who were hospitalized and received balloon-occluded retrograde transvenous obliteration(BRTO)combined with endoscopic tissue adhesive injection or EUS-guided coil placement combined with tissue adhesive injection in Xiangyang Central Hospital from March 2019 to September 2022.The two surgical procedures were compared in terms of efficacy(technical success rate,5-day rebleeding rate,1-year rebleeding rate,and time to rebleeding),safety(the incidence rate of ectopic embolism,the amount of tissue adhesive used,and the amount of lauromacrogol used),and cost-effectiveness(hospital costs and length of hospital stay).The ttest was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups.The Kaplan-Meier method was used to estimate the rebleeding.The chi-square test was used for comparison of categorical data between two groups.Results A total of 25 patients received successful EUS-guided coil placement and tissue adhesive injection,with a technical success rate of 100%,a median amount of 2.5 mL tissue adhesive used,a median amount of 11.0 mL lauromacrogol used,a mean length of hospital stay of 14.88±3.21 days,a mean hospital cost of 32660.00±4602.07 yuan,and a 5-day rebleeding rate of 0%;among these patients,2 were lost to follow-up,and 23 patients with complete follow-up data had an incidence rate of ectopic embolism of 0% and a median time to rebleeding of 689 days.A total of 14 patients underwent modified BRTO combined with endoscopic tissue adhesive injection,with a technical success rate of 100%;a median amount of 5.0 mL tissue a

关 键 词：食管和胃静脉曲张 自发性门体分流 超声内镜 球囊封堵逆行静脉闭塞术 

分 类 号：R575.2[医药卫生—消化系统]