改良的内镜下静脉曲张套扎术治疗肝硬化食管静脉曲张的疗效研究  

Efficacy study of modified endoscopic variceal ligation for the treatment of esophageal varices in cirrhotic patients

作　　者：马梓粼 张帅[1,3] 何占娣 王娟[1] 孙国辉[1] 黄昂[1] 杨竞[1] 钟立森 张晓彬[1] 刘迎娣[1] 令狐恩强[1] Ma Zilin;Zhang Shuai;He Zhandi;Wang Juan;Sun Guohui;Huang Ang;Yang Jing;Zhong Lisen;Zhang Xiaobin;Liu Yingdi;Linghu Enqiang(Department of Gastroenterology,The First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Chinese PLA Medical School,Beijing 100853,China;Department of Gastroenterology,The Ninth Medical Center of Chinese PLA General Hospital,Beijing 100101,China;Department of Gastroenterology,Shijingshan Hospital,Beijing 100043,China)

机构地区：[1]解放军总医院第一医学中心消化内科医学部,北京100853 [2]解放军总医院解放军医学院,北京100853 [3]解放军总医院第九医学中心消化内科,北京100101 [4]石景山医院消化内科,北京100043

出　　处：《中华胃肠内镜电子杂志》2024年第4期225-232,共8页Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)

基　　金：国家重点研发计划(2022YFC2503600)

摘　　要：目的比较基于高危出血部位改良的内镜下静脉曲张套扎(MEVL)与常规内镜下静脉曲张套扎(EVL)在肝硬化食管静脉曲张患者中的疗效。方法前瞻性收集2022年3月至2023年3月在解放军总医院第一医学中心消化内科医学部诊断为肝硬化食管静脉曲张并拟行首次EVL的69例患者,纳入基于高危出血部位改良的中下段套扎组。回顾性收集2018年2月至2022年2月在同中心诊断为肝硬化食管静脉曲张并已行首次EVL的271例患者,纳入采用常规的下段套扎组。倾向性评分匹配后对比两组患者EVL术中术后治疗效果、不良事件等结果。继续对患者进行12个月的随访,最终采用意向性治疗(ITT)分析和Kaplan-Meier的方法与符合方案集(PP)分析聚焦患者的生存问题进行分析。结果经倾向性评分匹配后两组基线数据具有可比性。中下段套扎组术中脱落环数多于下段套扎组,术后胸痛VAS评分更高,两者均有统计学差异(P<0.05)。ITT分析中随访6个月时,中下段套扎组食管静脉曲张无复发生存率大于下段套扎组,存在统计学差异(P<0.05)。PP分析中,中下段套扎组在随访6个月时食管静脉曲张复发率、12个月时食管静脉曲张出血率均低于下段套扎组,平均复发时间更长,且均存在统计学差异(P<0.05)。结论在肝硬化食管静脉曲张中,基于高危出血部位改良的内镜下静脉曲张套扎治疗是安全、有效的,且较常规套扎方法能够延长复发时间,降低术后6个月的复发率和12个月的出血率。Objective To compare the therapeutic efficacy of modified endoscopic variceal ligation targetinghigh-risk bleeding sites with conventional ligation methods in patients with cirrhosis-related esophageal varices.Methods Prospectively collected 69 patients diagnosed with cirrhosis-related esophageal varices and scheduled for their first EVL from March 2022 to March 2023 at the First Medical Center of Chinese PLA General Hospital were included in the modified lower-middle segment ligation group.Retrospectively collected 271 patients diagnosed with cirrhosis-related esophageal varices and who had undergone their first EVL from February 2018 to February 2022 at the same center were included in the conventional lower segment ligation group.After propensity score matching,the therapeutic effects,adverse events,and other indicators during and after EVL were compared between the two groups.Patients were followed up for 12 months,and the intention-to-treat analysis and Kaplan-Meier method were used to focus on patient survival issues,along with the per-protocol analysis.Results After propensity score matching,the baseline data of the two groups were comparable.The number of detached rings during the procedure and the postoperative chest pain VAS scores in the lower-middle segment ligation group were higher than those in the lower segment ligation group,with statistically significant differences(P<0.05).In the intention-totreat(ITT)analysis at the 6-month follow-up,the recurrence-free survival rate of esophageal varices in the lower-middle segment ligation group was greater than that in the lower segment ligation group,with statistically significant differences(P<0.05).In the per-protocol(PP)analysis,the esophageal varices recurrence rate at 6 months and the bleeding rate at 12 months in the lower-middle segment ligation group were both lower than those in the lower segment ligation group,with a longer average time to recurrence,and all with statistically significant differences(P<0.05).Conclusion In patients with cirrhosis-

关 键 词：食管静脉曲张 内镜治疗 改良套扎治疗 

分 类 号：R575.2[医药卫生—消化系统]