非急诊状态食管静脉曲张套扎联合胃静脉曲张密集套扎的有效性及安全性  

Efficacy and safety of esophageal variceal ligation combined with gastric variceal intensive ligation in non-emergency settings

作　　者：李佳鑫 徐闪闪 全润钊 张昊 卢曼曼 李贞娟 马赛 米俊 丁辉 张慧敏 付琳 李修岭 Li Jiaxin;Xu Shanshan;Quan Runzhao;Zhang Hao;Lu Manman;Li Zhenjuan;Ma Sai;Mi Jun;Ding Hui;Zhang Huimin;Fu Lin;Li Xiuling(Department of Gastroenterology,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,School of Clinical Medicine,Henan University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院,郑州大学人民医院,河南大学临床医学院消化内科,郑州450003

出　　处：《中华消化内镜杂志》2025年第1期34-41,共8页Chinese Journal of Digestive Endoscopy

基　　金：河南省医学科技攻关计划项目(2022ZY1213)。

摘　　要：目的评价肝硬化食管胃静脉曲张破裂出血非急诊状态下食管静脉曲张行内镜下曲张静脉套扎术(endoscopic variceal ligation,EVL)联合胃静脉曲张行内镜下曲张静脉密集套扎术(endoscopic variceal intensive ligation,EVIL)的疗效和安全性。方法2017年1月至2023年3月间,因肝硬化伴食管胃静脉曲张破裂出血在河南省人民医院消化内科住院治疗的643例连续病例纳入回顾性研究,排除451例后,纳入192例,其中149例食管曲张静脉EVL联合胃静脉曲张EVIL治疗者纳入EVIL组,43例食管曲张静脉EVL联合胃静脉曲张内镜下组织胶注射术(endoscopic tissue adhesive injection,ETAI)治疗者纳入ETAI组,对比分析2组内镜治疗成功率、食管曲张静脉套扎环数、内镜治疗操作时间、住院时间、再出血率、死亡率和不良事件发生率。结果EVIL组内镜治疗成功率明显高于ETAI组[100.0%(149/149)比95.3%(41/43),P=0.049],食管曲张静脉套扎环数略多于ETAI组[8(6,11)环比7(6,9)环,Z=-1.29,P=0.196],内镜治疗操作时间明显短于ETAI组[27.0(20.5,34.0)min比36.0(21.0,51.0)min,Z=-2.30,P=0.021],住院时间明显短于ETAI组[10(7,13)d比13(9,15)d,Z=-3.02,P=0.003]。EVIL组术后24、72、120 h内,早期、迟发性和总再出血率分别为0.0%(0/149)、0.0%(0/149)、0.7%(1/149)、2.0%(3/149)、12.8%(19/149)和14.8%(22/149),ETAI组对应分别为4.7%(2/43)(P=0.049)、9.3%(4/43)(P=0.002)、9.3%(4/43)(χ^(2)=6.69,P=0.010)、4.7%(2/43)(χ^(2)=0.17,P=0.679)、30.2%(13/43)(χ^(2)=7.34,P=0.007)和44.2%(19/43)(χ^(2)=17.20,P<0.001)。2组均无与再出血相关的术后6周内死亡。EVIL组术后1年内再出血死亡率、随访期内再出血死亡率分别为1.3%(2/149)、3.4%(5/149),ETAI组对应分别为0.0%(0/43)(P=1.000)、2.3%(1/43)(χ^(2)=0.02,P=0.876)。EVIL组术后发热、胸痛、恶心或呕吐发生率分别为12.1%(18/149)、14.1%(21/149)、13.4%(20/149),ETAI组对应分别为11.6%(5/43)(χ^(2)=0.01,P=0.936)、16.3%(7/43)(χ^(2)=0.13,P=0.721)、18.6%(8/ObjectiveTo evaluate the efficacy and safety of endoscopic variceal ligation(EVL)of esophageal varices combined with endoscopic variceal intensive ligation(EVIL)of gastric varices for gastroesophageal variceal bleeding with liver cirrhosis under non-emergency settings.MethodsData of 643 consecutive patients with gastroesophageal variceal bleeding due to liver cirrhosis admitted to the Department of Gastroenterology,Henan Provincial People's Hospital from January 2017 to March 2023 were included in the retrospective study.A total of 192 patients were included after excluding 451 patients.One hundred and forty-nine patients who underwent EVL of esophageal varices combined with EVIL of gastric varices were enrolled into the EVIL group,while 43 patients who underwent EVL of esophageal varices combined with endoscopic tissue adhesive injection(ETAI)of gastric varices were enrolled into the ETAI group.The endoscopic treatment success rate,esophageal variceal ligations number,operation time of endoscopic treatment,hospitalization time,rebleeding rate,mortality and the incidence of adverse events were compared between the two groups.ResultsCompared with the ETAI group,the EVIL group exhibited significantly higher endoscopic treatment success rate[100.0%(149/149)VS 95.3%(41/43),P=0.049],slightly greater esophageal variceal ligations number[8(6,11)rings VS 7(6,9)rings,Z=-1.29,P=0.196],shorter operation time of endoscopic treatment[27.0(20.5,34.0)min VS 36.0(21.0,51.0)min,Z=-2.30,P=0.021],and significantly shorter hospitalization time[10(7,13)d VS 13(9,15)d,Z=-3.02,P=0.003].The rebleeding rate within 24,72,120 hours after the operation,early,delayed and total rebleeding in the EVIL group were 0.0%(0/149),0.0%(0/149),0.7%(1/149),2.0%(3/149),12.8%(19/149)and 14.8%(22/149)respectively,and 4.7%(2/43)(P=0.049),9.3%(4/43)(P=0.002),9.3%(4/43)(χ^(2)=6.69,P=0.010),4.7%(2/43)(χ^(2)=0.17,P=0.679),30.2%(13/43)(χ^(2)=7.34,P=0.007)and 44.2%(19/43)(χ^(2)=17.20,P<0.001)in the ETAI group,respectively.No death related to rebleeding occur

关 键 词：肝硬化 食管和胃静脉曲张 非急诊内镜 内镜下曲张静脉套扎术 内镜下曲张静脉密集套扎术 内镜下组织胶注射术 再出血 

分 类 号：R575.2[医药卫生—消化系统]