内镜下胃底静脉曲张套扎术与组织胶注射术临床疗效回顾性分析
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摘要
目的探讨内镜下胃底静脉曲张套扎术与组织胶注射术临床疗效。方法选取2015年1月～2017年12月在我院进行治疗的胃底静脉曲张出血患者240例,采用随机数字表法将患者分为两组。套扎组行内镜下胃底静脉套扎术治疗120例;注射组行内镜下胃底静脉组织注射胶术治疗120例;以上患者均是胃底静脉曲张破裂出血住院患者,在48h内进行内镜下治疗,目的是止血,术后1、6个月复查胃镜,所有病例未做胃镜下二级预防性治疗,全部病例追踪随访。结果套扎组患者止血成功率(95.00%)高于注射组(88.33%),术后1月内及6月内的再出血率(5.00%、0)要低于注射组(6.67%、1.67%),套扎组患者胃底静脉曲张改善总有效率(94.17%)要高于注射组(87.50%),套扎组患者在术后发热、疼痛、异位栓塞、败血症及病死率(2.50%、3.33%、1.67%、4.17%、0)均要低于注射组(4.17%、6.67%、2.50%、5.83%、0.83%),上述所有指标两组比较差异无统计学意义(P> 0.05)。结论胃底静脉套扎组与胃底静脉组织胶注射组效果无差异,胃底静脉套扎治疗组无注射针眼出血情况,无排胶现象,止血成率高,且操作较简单,费用较低,操作风险较少,适推广。
Objective To explore clinical curative effects of endoscopic gastric varices ligation and tissue adhesive injection. Methods Two hundred and forty patients with gastric varices bleeding who were treated in Huadu District People's Hospital of Guangzhou from January 2015 to December 2017 were selected and they were divided into two groups by random number table method.120 patients in the ligation group underwent endoscopic gastric varices ligation while 120 patients in the injection group underwent endoscopic tissue adhesive injection in fundus venous tissues.The above patients were all hospitalized patients with gastric varices rupture and bleeding.They were treated with endoscopic therapy within 48 hours,with the purpose of hemostasis.Gastroscopy was reviewed in 1 month and 6 months after the operation and all the cases were not treated with secondary prophylactic treatment under gastroscopy.All the cases were followed up. Results The success rate of hemostasis in the ligation group(95.00%)was higher than that in the injection group(88.33%).The rates of rebleeding within one month and six months after operation(5.00%,0)in the ligation group were lower than those in the injection group(6.67%,1.67%).The total effective rate of gastric varices improvement in the ligation group(94.17%)was higher than that in the injection group(87.50%).Incidence of postoperative fever,pain,ectopic embolism,septicemia and mortality of patients(2.50%,3.33%,1.67%,4.17%,0)in the ligation group were all lower than those of the injection group(4.17%,6.67%,2.50%,5.83%,0.83%).There was no statistically significant difference in above indexes between the two groups(P > 0.05). Conclusion There was no difference in curative effects between endoscopic gastric varices ligation group and tissue adhesive injection in fundus venous tissue group.There is no injection needle hemorrhage and tissue adhesive discharge phenomenon.It has a high hemostasis rate,simple operation,low costs and less operation risks,so it is suitable for promotion.
Objective To explore clinical curative effects of endoscopic gastric varices ligation and tissue adhesive injection. Methods Two hundred and forty patients with gastric varices bleeding who were treated in Huadu District People's Hospital of Guangzhou from January 2015 to December 2017 were selected and they were divided into two groups by random number table method.120 patients in the ligation group underwent endoscopic gastric varices ligation while 120 patients in the injection group underwent endoscopic tissue adhesive injection in fundus venous tissues.The above patients were all hospitalized patients with gastric varices rupture and bleeding.They were treated with endoscopic therapy within 48 hours,with the purpose of hemostasis.Gastroscopy was reviewed in 1 month and 6 months after the operation and all the cases were not treated with secondary prophylactic treatment under gastroscopy.All the cases were followed up. Results The success rate of hemostasis in the ligation group(95.00%)was higher than that in the injection group(88.33%).The rates of rebleeding within one month and six months after operation(5.00%,0)in the ligation group were lower than those in the injection group(6.67%,1.67%).The total effective rate of gastric varices improvement in the ligation group(94.17%)was higher than that in the injection group(87.50%).Incidence of postoperative fever,pain,ectopic embolism,septicemia and mortality of patients(2.50%,3.33%,1.67%,4.17%,0)in the ligation group were all lower than those of the injection group(4.17%,6.67%,2.50%,5.83%,0.83%).There was no statistically significant difference in above indexes between the two groups(P > 0.05). Conclusion There was no difference in curative effects between endoscopic gastric varices ligation group and tissue adhesive injection in fundus venous tissue group.There is no injection needle hemorrhage and tissue adhesive discharge phenomenon.It has a high hemostasis rate,simple operation,low costs and less operation risks,so it is suitable for promotion.
引文
[1]苏林龙.内镜下组织胶注射及套扎术治疗食管胃底静脉曲张疗效分析[J].北方药学,2017,14(4):180-181.
[2]文海,张太坤,陈文忠.内镜下组织胶注射联合套扎术治疗肝硬化食管胃底静脉曲张破裂出血的临床价值[J].中国医学前沿杂志(电子版),2017,9(5):111-114.
[3]王智慧,邝文超,周海飞,等.内镜下组织胶注射联合套扎术治疗食道胃底静脉曲张出血的疗效观察[J].黑龙江医学,2017,41(3):243-244.
[4]中华医学会消化内镜学分会.食管胃静脉曲张内镜下诊断和治疗规范试行方案(2003年)[J].中华消化内镜杂志,2004,21(3):5-7.
[5]Koch D.Update in the management of gastric varices[J].Current Opinion in Gastroenterology,2016,32(3):166.
[6]Bhat YM,Weilert F,Fredrick RT,et al.EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue:a large U.S.experience over 6 years(with video)[J].Gastrointestinal Endoscopy,2016,83(6):1164-1172.
[7]Belletrutti PJ,Romagnuolo J,Hilsden RJ,et al.Endoscopic management of gastric varices:efficacy and outcomes of gluing with N-butyl-2-cyanoacrylate in a North American patient population[J].Canadian Journal of Gastroenterology,2016,22(11):931-936.
[8]李洁,范明娟,辜金莲,等.内镜下胃底组织胶注射联合套扎术治疗肝硬化食管胃底静脉曲张的效果及安全性[J].中国当代医药,2016,23(27):37-39.
[9]胡华华,许捷鸿,易宏.经内镜组织胶注射术治疗胃底静脉曲张破裂出血对门脉高压性胃病的影响分析[J].医学临床研究,2016,33(12):2318-2321.
[10]Zeng XQ,Ma LL,Tseng YJ,et al.Endoscopic cyanoacrylate injection with or without lauromacrogol for gastric varices:A randomized pilot study[J].JGastroenterol Hepatol,2017,32(3):631.
[11]Zuiki T,Hosoya Y,Sakuma Y,et al.Laparoscopic gastric devascularization without splenectomy is effective for the treatment of gastric varices[J].International Journal of Surgery Case Reports,2016,19(3):119-123.
[12]刘文琴,鲍红梅.食管胃底静脉曲张出血内镜下套扎及组织胶注射术后再出血的危险因素探讨[J].现代消化及介入诊疗,2017,22(2):242-244.
[13]田峰,林海,陈兴田.一种组织胶改良注射方法联合食管套扎治疗食管胃静脉曲张的临床疗效[J].实用医学杂志,2017,33(17):2873-2876.
[14]Philips CA,Sahney A.Oesophageal and gastric varices:historical aspects,classification and grading:everything in one place[J].Gastroenterology Report,2016,4(3):186-195.
[15]庞红全,杨帆,余瑞金.内镜下注射聚桂醇与组织胶治疗肝硬化食管胃底静脉曲张的近远期疗效比较[J].现代消化及介入诊疗,2016,21(4):527-530.
[2]文海,张太坤,陈文忠.内镜下组织胶注射联合套扎术治疗肝硬化食管胃底静脉曲张破裂出血的临床价值[J].中国医学前沿杂志(电子版),2017,9(5):111-114.
[3]王智慧,邝文超,周海飞,等.内镜下组织胶注射联合套扎术治疗食道胃底静脉曲张出血的疗效观察[J].黑龙江医学,2017,41(3):243-244.
[4]中华医学会消化内镜学分会.食管胃静脉曲张内镜下诊断和治疗规范试行方案(2003年)[J].中华消化内镜杂志,2004,21(3):5-7.
[5]Koch D.Update in the management of gastric varices[J].Current Opinion in Gastroenterology,2016,32(3):166.
[6]Bhat YM,Weilert F,Fredrick RT,et al.EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue:a large U.S.experience over 6 years(with video)[J].Gastrointestinal Endoscopy,2016,83(6):1164-1172.
[7]Belletrutti PJ,Romagnuolo J,Hilsden RJ,et al.Endoscopic management of gastric varices:efficacy and outcomes of gluing with N-butyl-2-cyanoacrylate in a North American patient population[J].Canadian Journal of Gastroenterology,2016,22(11):931-936.
[8]李洁,范明娟,辜金莲,等.内镜下胃底组织胶注射联合套扎术治疗肝硬化食管胃底静脉曲张的效果及安全性[J].中国当代医药,2016,23(27):37-39.
[9]胡华华,许捷鸿,易宏.经内镜组织胶注射术治疗胃底静脉曲张破裂出血对门脉高压性胃病的影响分析[J].医学临床研究,2016,33(12):2318-2321.
[10]Zeng XQ,Ma LL,Tseng YJ,et al.Endoscopic cyanoacrylate injection with or without lauromacrogol for gastric varices:A randomized pilot study[J].JGastroenterol Hepatol,2017,32(3):631.
[11]Zuiki T,Hosoya Y,Sakuma Y,et al.Laparoscopic gastric devascularization without splenectomy is effective for the treatment of gastric varices[J].International Journal of Surgery Case Reports,2016,19(3):119-123.
[12]刘文琴,鲍红梅.食管胃底静脉曲张出血内镜下套扎及组织胶注射术后再出血的危险因素探讨[J].现代消化及介入诊疗,2017,22(2):242-244.
[13]田峰,林海,陈兴田.一种组织胶改良注射方法联合食管套扎治疗食管胃静脉曲张的临床疗效[J].实用医学杂志,2017,33(17):2873-2876.
[14]Philips CA,Sahney A.Oesophageal and gastric varices:historical aspects,classification and grading:everything in one place[J].Gastroenterology Report,2016,4(3):186-195.
[15]庞红全,杨帆,余瑞金.内镜下注射聚桂醇与组织胶治疗肝硬化食管胃底静脉曲张的近远期疗效比较[J].现代消化及介入诊疗,2016,21(4):527-530.