食管/食管+胃静脉曲张结扎术治疗胃静脉曲张的对比研究

Esophageal versus esophageal and gastric variceal band ligation in management of bleeding gastric varices: a retrospective study of 231 cases

目的评估内镜下行食管、胃底静脉曲张结扎术(esophageal and gastric variceal band ligation,EGVL)和单独行食管静脉曲张结扎术(esophageal variceal band ligation,EVL)治疗不同类型胃静脉曲张(gastric varices,GV)的有效性,并分析影响术后效果的因素。方法回顾性总结我院90例行EGVL治疗(EGVL组)和141例行EVL治疗(EVL组)的GV患者的临床资料;对比分析2组及各型GV间在GV曲张度、术后GV消除率、再出血率、复发率、生存时间等方面的差异,分析胃/脾-肾分流对GV患者术后疗效的影响。结果 2组2型食管胃静脉曲张(gastroesophageal varices type 2,GOV2)间GV曲张度差异有统计学意义(P<0.01);EGVL组:止血成功率97.8%,消除率92.2%,复发率13.3%,再出血率18.2%;EVL组:止血成功率92.9%,消除率55.2%,复发率10.8%,再出血率32.8%,曲张静脉消除率和再出血率差异有统计学意义(χ2=35.155,P<0.01;χ2=5.734,P=0.017),2组间复发率无统计学差异(P>0.05);2组1型食管胃静脉曲张(GOV1)间、GOV1+GOV2间的消除率和再出血率差异有统计学意义(P<0.01);2组GOV2间仅消除率差异有统计学意义(P<0.01),但再出血率差异无统计学意义(P>0.05);2组相同型别间的生存时间无统计学差异(P>0.05)。上腹部CTA结果示:58.3%(42/72)的GV伴胃/脾-肾分流,有、无胃/脾-肾分流患者之间GV复发率和再出血率差异有统计学意义(χ2=9.914,P<0.01;χ2=7.200,P<0.01)。结论 GV患者在行EGVL术后GV消除、再出血优于EVL术。EGVL和EVL治疗各型GV急性出血及预防再出血是有效的。胃/脾-肾分流对GV复发和再出血有影响。

Objective To assess the efficacy of esophageal and gastric variceal band ligation（ EGVL）vs esophageal variceal band ligation（ EVL） on the treatment of different types of gastric varices（ GV）,and investigate the influencing factors of postoperative outcomes. Methods A total of 231 patients with GV who received these 2 types of treatment in our department from January 2010 to December 2013 were retrospectively enrolled in this study. There were 90 patients receiving EGVL and the other 141 patients undergoing EVL.Their clinical data were collected and retrospectively summarized. Their GV varices,postoperative elimination rate,rebleeding rate,recurrence rate and survival time were compared between the 2 groups to analyze the effect of the gastrorenal or splenorenal shunts on postoperative patients with GV. Results There was significant difference in the degree of GV varices between the 2 surgical approaches for gastroesophageal varices type 2（ GOV2）（ P〈 0.01）. In EGVL group,the hemostasis rate was 97. 8%,the eliminating rate was 92.2%,the recurrence rate was 13. 3%,and the rebleeding rate was 18. 2%. While for the EVL group,the hemostasis rate was 92. 9%,the eliminating rate was 55. 2%,the recurrence rate was 10. 8%,and the rebleeding rate was 32. 8%. Significant differences were found in the elimination rate and rebleeding rate（ Chi square = 35. 155,P〈 0.01; Chi square = 5. 734,P = 0. 017）,but no difference was seen in the recurrence rate（ P〉 0.05）. For gastroesophageal varices type 1（ GOV1） or GOV1 ＋ GOV2,there were differences in the eliminating rate and rebleeding rate between the 2 approaches（ P〈 0.01）. But for GOV2,significant difference was found in the elimination rate（ P〈 0.01）,but not in the rebleeding rate（ P〉 0.05） between the2 approaches. There was no obvious difference in the survival time for GOV1 and GOV2 by neither approaches（ P〉 0.05）. The results of upper abdomen CTA exhibited that of the 58. 3%（ 42/72） GV patients with gastrorenal or splenorenal shunts,there were differences in recurrence rate of GV and rebleeding rate between those with and without the gastrorenal or splenorenal shunts（ Chi square = 9. 914,P〈 0.01; Chi square = 7.200,P〈 0.01）. Conclusion EGVL is superior to EVL in the terms of postoperative GV elimination and rebleeding. Both EGVL and EVL are effective in the treatment of GV bleeding and prevention of rebleeding.The gastrorenal or splenorenal shunts have effect on the GV recurrence and rebleeding.