内镜下聚桂醇联合组织胶改良注射与传统注射治疗2型胃食管静脉曲张的疗效对比

Comparison of efficacy of endoscopic lauromacrogol combined with tissue adhesive by modified sandwich injection method and conventinal injection in the treatment of type 2 gastroesophageal varices

目的:评价内镜下聚桂醇联合组织胶改良三明治注射治疗2型胃食管静脉曲张(GOV2)的临床疗效。方法:对照组为传统组织胶三明治治疗(碘油-组织胶-碘油),共53例;改良组为聚桂醇联合组织胶改良三明治治疗(聚桂醇-组织胶-聚桂醇),共92例,比较两组止血成功率、胃静脉曲张改善情况、再出血率、并发症发生率。结果:两组术后平均随访时间分别为(15.13±7.5)月、(14.75±7.31)月,两组止血成功率均为100%,术后静脉消失率分别为18.9%、34.8%,有效率分别为43.4%、43.5%,总体有效率分别为62.3%、78.3%,再出血率分别为39.6%、33.7%,其中总体有效率和静脉消失率差别有统计学意义,并且静脉曲张消除与缓解时间有明显差异(P<0.05)。对照组术后出现1例肺栓塞,改良组未出现异位栓塞,两组并发症比较无明显差异。结论:内镜下聚桂醇联合组织胶改良三明治治疗GOV2的疗效优于传统组织胶注射治疗。

Objective： To assess the clinical effect of endoscopic lauromacrogol combined with tissue adhesive by modified sandwich injection on the treatment of type 2 gastroesophageal varices（GOV2）. Methods：A retrospective study was performed to review the clinical and follow up data of 145 patients with GOV2 bleeding who had initially received tissue adhesive injection. The control group of 53 cases was treated with the traditional sandwich method（lipiodol- tissue adhesive- lipiodol）, while the modified group including 92 cases was treated with the modified sandwich method（lauromacrogol-tissue adhesive- lauromacrogol）. Then the hemostatic rate, improvement of gastric varices, rebleeding rate and incidence of complications were compared between two groups. Results：The average follow-up time for two groups were（15.13 ±7.5） months and（14.75 ±7.31） months respectively. The hemostatic rates of two groups were both 100%, the eradication rate of gastric varices were 18.9%, 34.8% respectively, the effective rates were 43.4% and 43.5% respectively, the total effective rates were 62.3% and 78.3% respectively, and the rebleeding rates were 39.6% and 33.7% respectively. The differences in the total effective rate and the eradication rate between two groups were statistically significant, and the time to eradicate and remit varices also had showed significant differences（P〈0.05）. One patient in control group had pulmonary embolism while no one had distant embolisms in modified group. No difference between two groups in complications were found. Conclusion：For the treatment of GOV2, endoscopic lauromacrogol combined with tissue adhesive is more effective than traditional tissue adhesive.