内镜硬化联合组织粘合剂治疗食管胃底静脉曲张及其对门静脉血流动力学的影响

Clinical value and effect on haemodynamics of portal system of sclerotherapy combined with endoscopic injection of tissue adhesive for esophagogastric varices

目的:评价内镜下注射硬化剂、组织粘合剂与内镜下组织粘合剂联合硬化剂注射三种方法治疗食管胃底静脉曲张的疗效及其对门静脉血流动力学的影响.方法:对147例食管胃静脉曲张患者分别进行内镜下注射硬化剂(单纯硬化剂组75例),组织粘合剂(单纯组织粘合剂组34例)与内镜下组织粘合剂联合硬化剂(硬化加粘合剂组38例)三种治疗方法的比较,术后随访止血率、再出血发生率、曲张静脉曲张消失率、并发症发生率等指标,并对三组治疗前后门静脉及其属支的血流动力学指标(门静脉、脾静脉、胃左静脉、脐静脉及肠系膜上静脉的管径、血流速度、血流量)进行了系统观察比较.结果:硬化加粘合剂组的急诊止血率明显高于其余两组(P<0.05);三组患者术后并发症发生率比较,差异无统计学意义;三组患者的曲张静脉消失率存在显著差异,硬化加粘合剂组明显高于其余两组(P<0.05),单纯硬化剂组明显高于单纯组织粘合剂组(P<0.05);近期和远期再出血发生率比较,三组患者存在统计学差异,单纯组织粘合剂组最高,硬化加粘合剂组稍低于单纯硬化剂组,但差异无统计学意义;三组患者治疗后门静脉血管内径均较治疗前减小,脾静脉血管内径均增加,但差异无统计学意义,而胃左静脉、脐静脉及肠系膜静脉血管内径无显著变化;三组门静脉、脾静脉的平均血流速度与血流量均较治疗前显著增加(P<0.05),胃左静脉、脐静脉和肠系膜静脉的平均血流速度与血流量变化不大.结论:内镜硬化联合组织粘合剂治疗食管胃底静脉曲张,具有安全性高、止血效果肯定、再出血发生率低,并发症少等诸多优点,同时治疗后可能不会明显加重门静脉高压,并能改善回肝血流,且对于门静脉的属支均无明显影响.

AIM：To investigate the effects of sclerotherapy,endoscopic injection of tissue adhesive alone and combine them in the treatment of esophagogastric varices.METHODS：A total of 147 cases with from esophagogastric varices were randomly assigned to receive emergent endoscopic variceal sclerotherapy alone（sclerotherapy alone group,75 cases）,injection of tissue adhesive alone（tissue adhesive alone group,34 cases） and combine sclerotherapy with injection of tissue adhesive（combine sclerotherapy with tissue adhesive group,38 cases）.The recent effective hemostatic rates,the eradicative rates and the early,late relapsed bleeding rates were observed.Color Doppler sonography was employed to measure the dynamical changes of portal vein and its branch vein before and after endoscopic treatment.Including the inside diameter,blood flow velocity and blood flow rate of portal vein,spleen vein,left gastric vein,umbilical vein and mesenteric vein.RESULTS：The recent effective hemostatic rates and the eradicative rates of combine sclerotherapy with tissue adhesive group were higher than that of other two groups and there were no significant difference among the rate of syndrome in 3 groups.The early relapsed bleeding rates and the late relapsed bleeding rates in 3 groups were significantly different,the highest was tissue adhesive alone group.The inside diameter of portal vein in 3 groups decreased after treatment and that of spleen vein increased,but there were not significantly different compared with before treatment.The inside diameter of other branch were not significantly different,too.The blood flow velocity and blood flow rate of portal vein and spleen vein increased significantly compared with before treatment and that of other branch were not significantly different.CONCLUSION：Combined sclerotherapy with endoscopic injection of tissue adhesive is more effective and safer for EGVB in controlling active bleeding,eradicative rate and the relapsed bleeding rates.After treatment,the pressure of protal vein don＇t increase and the blood flow velocity and blood flow rate could increased.There wasn＇t influence for the branch of portal vein.