摘要
目的分析内镜下静脉曲线套扎治疗(gastric variceal ligation,GVL)和组织黏合剂内镜下静脉曲线栓塞术(gastric variceal obturation,GVO)两种方法对胃静脉曲张的疗效,比较和评价两种内镜下治疗方法对胃静脉曲张的治疗效果,为临床治疗胃静脉曲张提供参考。方法选择2010年1月至2013年12月经西安交通大学第二附属医院消化内科和感染科住院治疗的胃静脉曲张患者93例,其中48例接受GVL治疗,45例接受GVO治疗,随访两组患者的临床和内镜下资料,比较分析两种治疗方法的曲张静脉消除率、曲张静脉复发率、初始止血成功率、再出血率、死亡率和并发症发生率,从而评价两种方法对胃静脉曲张的治疗效果。结果 GVL组和GVO组最终达到胃静脉曲张消除的患者分别为64.6%和62.2%,无显著性差异(P=0.813)。两种方法对胃静脉曲张急性出血的止血成功率均较高且无显著性差异(GVL组91.7%,GVO组100%,P>0.05)。GVL和GVO治疗后分别有31.3%和26.7%的患者发生再出血,总体再出血率无显著性差异(P=0.672)。Kaplan-Meier分析显示两组的累积再出血率也无显著性差异(P=0.582)。但对于1型孤立性胃静脉曲张,GVO组的再出血率低于GVL组(P=0.037)。两种治疗方法术后并发症的发生率及死亡率的差异无统计学意义(P>0.05),累积生存率亦无显著性差异(P=0.350)。GVO治疗和GVL治疗对胃静脉曲张的消除效果无显著性差异。在控制胃静脉曲张急性出血方面,GVL和GVO的疗效相当,且术后并发症发生率和死亡率无显著性差异。结论 GVO治疗胃静脉曲张是一种安全有效的方法,但仍需注意栓塞并发症尤其是系统栓塞并发症的发生。GVL可作为胃静脉曲张治疗的一种选择,尤其对于GOV1型和GOV2型治疗效果较好。
Objective To analyze and evaluate the efficacy of gastric variceal ligation ( GVL) and gastric variceal obturation ( GVO) for patients with gastric varices , accordingly providing some reference for the clinical treatment of gastric varices .Methods Ninty-three patients with gastric varices were included at the Second Affiliated Hospital of Xi′an Jiaotong University from January 2010 to December 2013 .Among them,48 patients received GVL and 45 received GVO.Recording clinical and endscopic change after treatment, we compared elimination coefficient , recurrence rate and rebleeding rate , mortality and complications between two groups ( GVL and GVO) .By comparing the above items ,we finally evaluated the efficacy of GVL and GVO for gastric varices .Results In patients who received GVL , 64.6% of them achieved obliteration of varicose veins , while 62.2% with GVO.There was no significant difference between two groups (P=0.813).GVL and GVO were both effective in controlling acute gastric varices bleeding,and the difference between two methods had no statistical significance (GVL 91.7%,GVO 100%, P>0.05).Rebleeding occurred in 31.3%patients in the GVL group and 26.7%in the GVO group (P=0.672).The rebleeding rate was still higher in IGV1 petients compared with GOV1 and GOV2 ( P =0.037).Complications and mortality rates showed no significant difference between the groups ( P =0.608),as well as cumulative survival rates (P=0.350).The efficacy of GVL to obliterate gastric varices is similar to GVO.The ability of GVL to control active gastric variceal bleeding showed no difference to GVO, as well as complications and survival .Conclusions GVO is a safe and effective method for gastric varices, while it still needs to be aware of the occurrence of embolic complications especially systematic embolic complications .GVL is a feasible strategy to handle gastric varices , particularly for GOV1 and GOV2.
出处
《中华胃肠内镜电子杂志》
2015年第1期6-13,共8页
Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)
