内镜下套扎联合组织胶注射治疗食管静脉曲张破裂出血的临床疗效

Clinical effects of endoscopic ligation combined with tissue glue injection in treatment of esophageal variceal bleeding

目的:探讨内镜下套扎联合组织胶注射治疗食管静脉曲张破裂出血的临床疗效.方法:选取2007-01/2013-03来武汉市第三医院进行治疗的肝硬化食管胃底静脉曲张出血患者229例,根据治疗情况将患者分为三组:硬化剂联合组织胶治疗组65例、保守治疗组76例及组织胶注射联合套扎术治疗组88例,观察以上三组的临床疗效;按是否行无痛胃镜将组织胶注射联合套扎术治疗组分为无痛组46例、普通组42例,分析手术前后心率(heart rate,HR)、血压(blood pressure,BP)及血氧饱和度(SpO2)指标.结果:不同治疗组间一般疗效指标的比较:组织胶注射联合套扎术治疗组的近期出血6例(6.8%),远期出血8例(9.0%),并发症发生2例(2.3%),死亡3例(3.4%),除并发症发生率(保守治疗组无并发症发生),组织胶注射联合套扎术治疗组的疗效指标数值均小于保守治疗组及硬化剂联合组织胶组.组织胶注射联合套扎术治疗组与硬化剂联合组织胶组相比,远期出血率、并发症发生率及死亡率的差异有统计学意义(P<0.05).组织胶注射联合套扎术治疗组与保守治疗组相比,近期出血率、远期出血率及死亡率的差异有统计学意义(P<0.05).不同治疗组间内镜下疗效指标的比较:组织胶注射联合套扎术治疗组显效57例(64.8%),有效21例(23.8%),无效10例(11.3%),总效率88.6%.与其他两组相比,显效率和总效率明显提高且差异有统计学意义(P<0.05).无痛组和普通组手术前后心率和血氧饱和度无明显统计学差异,无痛组手术后血压低于普通组(P<0.05).结论:内镜下组织胶注射联合套扎术的治疗效果较好,而且并发症和死亡率均较低,总有效率较高,是食管胃底静脉曲张破裂出血的首选止血方式.

AIM：To evaluate the clinical effects andsecurity of endoscopic variceal ligation（EVL）combined with tissue glue injection in the treatment of esophageal variceal bleeding.METHODS：A total of 229 patients with gastric variceal bleeding（EGVB） treated at Wuhan No.3 Hospital from January 2007 to March2013 were selected.The patients were divided into three groups：a sclerotherapy plus tissue glue group（n = 65）,a conservative treatment group（n = 76） and an EVL plus tissue glue group（n = 88）.The clinical effects of the three groups were observed.According to the use of painless endoscopy or not,the EVL plus tissue glue group was divided into two groups：a painless group（n = 46） and a normal group（n =42）.Blood pressure（BP）,heart rate（HR）,and hemoglobin oxygen saturation levels（SpO_2）were compared.RESULTS：In the EVL plus tissue glue group,there were 6（6.8%） cases of early hemorrhage（6.8%）,8（9.0%） cases of late hemorrhage,2（2.3%） cases of complications,and 3（3.4%） of death.Except the incidence of complications（the conservative treatment group had no complications）,the above parameters were significantly less in the EVL plus tissue glue group than in the other two groups（P〈0.05）.With regards to endoscopic curative effect,in the EVL plus tissue glue group,marked improvement was achieved in 57（64.8%） cases,improvement in 21（23.8%） and no improvement in 10（11.3%）,with a total effective rate of 88.6%.Compared with the other two groups,the endoscopic curative effect and total effective rate were significantlybetter in the EVL plus tissue glue group（P〈0.05）.Between the painless and normal groups,there were no significant differences in heart rate or blood oxygen saturation before and after operation.Postoperative blood pressure was lower in the painless group than in the normal group.CONCLUSION：The curative effect of EVL combined with tissue adhesives is better,the complication and mortality are very low,and the total effective rate is higher.