内镜组织黏合剂注射联合套扎序贯治疗食管胃静脉曲张疗效观察

Efficacy of Sequential Therapy of Endoscopic Tissue Adhesive Injection with Variceal Ligation for Esophagogastric Varices

背景:临床上对胃静脉曲张(GV)合并食管静脉曲张(EV)的内镜治疗方法和治疗时机选择尚未统一。目的:探讨内镜组织黏合剂注射联合套扎序贯治疗食管胃静脉曲张的疗效及其最佳时机。方法:2007年1月-2009年6月南京医科大学第一附属医院56例内镜检查确诊为GV活动性出血合并中重度EV者纳入研究,其中26例于GV组织黏合剂注射1周后行EV套扎(A组),30例注射后立即行EV套扎(B组)。回顾性分析两组患者的止血率、治疗相关并发症发生情况、治疗后1个月内和6个月内再出血率以及食管胃静脉曲张改善有效率。结果:A组与B组间止血率(96.2%对96.7%)和食管胃静脉曲张改善总有效率(GV:72.7%对72.0%;EV:81.8%对84.0%)无明显差异,A组治疗后1个月内和6个月内再出血率均显著高于B组(1个月内:26.1%对10.3%,P<0.05;6个月内:45.5%对32.0%,P<0.05)。两组均无明显治疗相关并发症发生。结论:内镜GV组织黏合剂注射后立即行EV套扎序贯治疗食管胃静脉曲张安全、有效,值得在临床上推广应用。

Background： The treatment modality and timing of endoscopic therapy of gastric varices （GV） complicated with esophageal varices （EV） is still controversial in clinical practice. Aims： To study the efficacy and optimum timing of sequential therapy of endoscopic tissue adhesive injection with varieeal ligation for esophagogastric variees. Methods： A total of 56 patients with active gastric variceal bleeding and moderate to severe EV proved by endoscopy at the First Affiliated Hospital of Nanjing Medical University from Jan. 2007 to Jun. 2009 were enrolled. Of them 26 patients （group A） received EV ligation one week after GV tissue adhesive injection and 30 patients （group B） received EV ligation instantly after injection. The hemostasis rate, procedure-related complication, 1-month and 6-month rebleeding rates and the improvement of esophagogastric varices in group A and group B were analyzed retrospectively. Results： There were no significant differences in the hemostasis rate （96.2% vs. 96.7%） and overall efficacy for esophagogastric varices （GV： 72.7% vs. 72.0%; EV： 81.8% vs. 84.0%） between group A and group B, but the 1-month and 6-month rebleeding rates in group A were significantly higher than those in group B （1-month： 26.1% vs. 10.3%, P〈0.05; 6-month： 45.5% vs. 32.0%, P〈0.05）. No severe procedure-related complication was observed in both groups. Conclusions： Sequential therapy of endoscopic GV tissue adhesive injection with instant EV variceal ligation is safe and effective for esophagogastric varices, and is worthy of wide application in clinical practice.