华南地区门静脉高压食管胃静脉曲张出血内镜治疗现状调研分析  

Investigation report on endoscopic management of esophagogastric variceal bleeding in portal hypertension in Southern China

作　　者：梁艳娉[1,2] 陈燕柔 梁运啸 白飞虎[5] 吴斌 王省[1,2] Liang Yanping;Chen Yanrou;Liang Yunxiao;Bai Feihu;Wu Bin;Wang Xing(Department of Gastroenterology,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Guangdong Province Engineering and Technology Research Center of Digestive Endoscopy,Guangzhou 510630,China;Zhongshan Medical School,Sun Yat-sen University,Guangzhou 510080,China;Department of Gastroenterology,The People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China;Department of Gastroenterology,The Second Affiliated Hospital of Hainan Medical University,Haikou 570216,China)

机构地区：[1]中山大学附属第三医院消化内科,广州510630 [2]广东省消化内镜工程技术研究中心,广州510630 [3]中山大学中山医学院,广州510080 [4]广西壮族自治区人民医院消化内科,南宁530021 [5]海南医学院第二附属医院消化内科,海口570216

出　　处：《中华消化病与影像杂志（电子版）》2024年第5期390-395,共6页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

基　　金：国家自然科学基金(82070574);广东省自然科学基金团队项目(2018B030312009)。

摘　　要：目的全面了解我国华南地区门静脉高压食管胃静脉曲张出血(EGVB)内镜治疗的现状。方法本研究通过网络分发调查问卷的方式全面了解华南地区广东省、广西壮族自治区及海南省开展门静脉高压EGVB内镜治疗的基本情况,包括预防EGVB的内镜治疗方案、急性EGVB的处理、胃底及特殊类型静脉曲张的处理、肝硬化门静脉高压的基础治疗与内镜治疗的随访等。医院的治疗方案选择使用百分率表示,并使用卡方检验或Fisher精确检验对不同省份医院对于我国指南的依从性进行比较分析。结果华南地区共81家医院参与调研,调查显示内镜治疗的最主要适应证是控制急性EGVB(60.5%)。参与调研医院对于我国指南中EGVB一级预防的推荐意见(单纯非选择性β受体阻滞剂或单纯内镜治疗)和二级预防推荐意见(非选择性β受体阻滞剂联合内镜治疗)的依从性为均为55.6%,不同省份之间无明显差异(P=0.976和0.186)。92.6%的医院首选内镜治疗处理急性EGVB,82.7%的医院在出血后12~24 h的时间窗内完成急诊内镜治疗。对于各种类型的胃底静脉曲张和异位静脉曲张,以组织胶为基础的内镜治疗(包括组织胶联合硬化剂注射和单纯组织胶注射)均为最常采用的术式。81.5%的医院将非选择性β受体阻滞剂常规用于肝硬化门静脉高压的治疗,主要使用的药物为普萘洛尔(80.2%)和卡维地洛(19.8%)。结论本研究证实多种预防和治疗EGVB的内镜治疗技术已在我国华南地区广泛开展,各级医院在开展急诊胃镜进行急性EGVB止血方面均较为积极,但对EGVB的一级预防和二级预防的总体指南依从性仍不理想,未来需进一步提升EGVB治疗的指南依从性。Objective To investigate the current situation of the use of endoscopic therapies for esophagogastric variceal bleeding(EGVB)in portal hypertension in Southern China area.Methods We carried out an online questionnaire survey to investigate the use of endoscopic therapies for EGVB in Guangdong province,Guangxi Zhuang Autonomous Region and Hainan province in South China.Questions included endoscopic choices for preventing EGVB,management of acute EGVB,management of gastric varices and special types of varices,fundamental treatment of cirrhosis-derived portal hypertension,and the follow up of endoscopic therapies.Hospital treatment options were expressed as percentage.Comparisons of guideline adherence among hospitals of different regions were performed with Chi-square or Fisher's exact test when appropriate.Results A total of 81 hospitals participated the study.The survey showed that the leading indication of endoscopic therapies was treating acute EGVB(60.5%).For primary and secondary prophylaxis of EGVB,adherence to national guideline was 55.6%,and no significant differences of the adherence were observed among different provinces(P=0.976 and 0.186,respectively).As much as 92.6%hospitals preferred endoscopic therapies treating acute EGVB,and most of the hospitals carried out emergency endoscopies within 12-24 hours after the presentation of bleeding(82.7%).In the treatment of various types of gastric varices and ectopic varices,cyanoacrylate injection-based procedures(including cyanoacrylate injection combined with sclerotherapy and cyanoacrylate injection alone)were the most prevalent procedures.81.5%hospitals routinely used non-selectiveβ-blockers for cirrhosis-derived portal hypertension,and main drugs were propranolol(80.2%)and carvedilol(19.8%).Conclusion This survey showcases that various endoscopic procedures for EGVB treatment have been conducted in Southern China.Participating hospitals are active to perform emergency endoscopies for acute EGVB,however,they are inadequate in following recommendations re

关 键 词：门静脉高压 食管胃静脉曲张出血 内镜治疗 套扎 硬化剂 组织胶 问卷调查 指南依从性 

分 类 号：R571.3[医药卫生—消化系统]