内镜下曲张静脉套扎联合药物治疗肝硬化并发食管静脉曲张破裂出血的疗效

Efficacy of endoscopic esophageal varix ligation combined with drugs in the treatment of liver cirrhosis complicated with esophageal gastric varix bleeding

目的探讨内镜下食管静脉曲张套扎术(endoscopic esophageal varix ligation,EVL)联合药物治疗肝硬化并发食管静脉曲张破裂出血的疗效。方法选择2017年7月—2019年6月经广东省廉江市人民医院治疗的82例肝硬化并发食管静脉曲张破裂出血患者,按非盲随机数字表法将其分为对照组和观察组,每组41例。对照组接受奥曲肽治疗,观察组接受EVL+奥曲肽联合治疗,两组均连续治疗5 d。记录两组止血时间、住院时间,治疗后1周依据食管曲张静脉改善程度评估临床疗效,并比较两组肝静脉压力梯度(hepatic venous pressure gradient,HVPG)、再出血发生率及不良反应。结果观察组总有效率(97.56%)高于对照组(80.49%),再出血发生率(14.63%)低于对照组(36.59%),止血时间(1.36±0.43)d、和住院时间(19.82±3.57)d短于对照组(2.89±0.57)d和(27.14±4.15)d,差异有统计学意义(P<0.05)。治疗前两组HVPG水平比较,差异无统计学意义(P>0.05);治疗后观察组HVPG(6.51±1.07)mm Hg(1 mm Hg=0.133 kPa),低于对照组(11.63±1.34)mm Hg,差异有统计学意义(P<0.05);观察组不良反应发生率(7.32%)低于对照组(14.63%),差异无统计学意义(P>0.05)。结论EVL+奥曲肽联合治疗肝硬化并发食管静脉曲张破裂出血能够提升止血效果,改善HVPG,减少再出血发生率,缩短止血时间及住院时间。

Objective To investigate the efficacy of endoscopic esophageal varix ligation(EVL)combined with drugs in the treatment of liver cirrhosis complicated with esophageal gastric varix bleeding.Methods A total of 82 patients with liver cirrhosis complicated with EVB who were treated in Lianjiang People’s Hospital between July 2017 and June 2019 were selected and divided into control and observation groups according to the random number table method,with 41 cases in each group.The control group received octreotide therapy,and the observation group received EVL+octreotide combined therapy.Both groups received continuous treatment for five days.The hemostasis and hospitalization times of the two groups were recorded.The clinical efficacy was evaluated according to the degree of varicose vein improvement one week after treatment.The hepatic venous pressure gradient(HVPG),the incidence of rebleeding,and adverse reactions were compared between the two groups.Results The total effective rate(97.56%)in the observation group was higher than that in the control group(80.49%).The incidence of rebleeding(14.63%)was lower than that in the control group(36.59%).The hemostasis time of(1.36±0.43)days and hospitalization time of(19.82±3.57)days were shorter than the respective times of(2.89±0.57)days and(27.14±4.15)days in the control group(P<0.05).There was no significant difference in HVPG levels between the two groups before treatment(P>0.05).After treatment,the HVPG in the observation group was(6.51±1.07)mm Hg(1 mm Hg=0.133 kPa),which was lower than(11.63±1.34)mm Hg in the control group(P<0.05).The incidence of adverse reactions in the observation group(7.32%)was lower than that in the control group(14.63%),and the difference was not statistically significant(P>0.05).Conclusion The combination of EVL and octreotide in the treatment of liver cirrhosis complicated with EVB can improve the hemostatic effect,improve HVPG,reduce the incidence of rebleeding,and shorten the hemostasis and hospitalization times.