胃静脉曲张黏合剂治疗对门脉高压性胃病的影响

The study of effect on portal hypertensive gastropathy after treating gastric varices by endoscopic injection of tissue adhesive

目的:探讨黏合剂治疗胃底静脉曲张对门脉高压性胃病(portal hypertensive gastropathy,PHG)的影响。方法:收集2013年1月至2015年8月乙型肝炎(乙肝)后肝硬化失代偿具有食管胃静脉曲张(GOV)或孤立性胃静脉曲张(IGV)的患者171例,应用硬化剂+黏合剂+硬化剂的改良"三明治"注射治疗法治疗。在治疗后3个月、6个月及1年随访,观察内镜治疗效果以及PHG的发生率变化。结果:171例患者进行内镜下硬化治疗共242例次。术后6个月治疗的有效率为98.8%(169例),术后12个月的有效率为88.9%(152例),存活率为98.2%(168例)。治疗前PHG的总发生率为35.5%,治疗3个月后,发生率为38.1%,与治疗前比较无显著性差异(P>0.05);治疗6个月及1年后,发生率分别为48.0%及84.2%,与治疗前相比,有显著性差异(P<0.05)。结论:胃底静脉曲张硬化治疗明显减少急性出血的死亡率,延长生存时间。PHG的发生率在黏合剂治疗后会有明显上升,需要采取多种联合治疗的方法减少PHG的发生,提高PHG患者的生活质量及生存率。

Objective To investigate the effect on portal hypertensive gastropathy（PHG） after treating the gastric varices by endoscopic injection of tissue adhesive.Methods Decompensated hepatitis B cirrhosis patients with gastric varices or isolated gastric varices from January 2013 to August 2015 were enrolled.The improved ＂sandwich＂ therapy with sclerosant＋tissue adhesive＋sclerosant was administrated.Patients were followed up at 3-month,6-month,and 1 year after treatment.The clinical efficacy of the endoscopy treatment and the change of incidence in PHG were observed.Results There were 171 patients received endoscopic sclerotherapy for 242 times.At 6-month and 12-month of follow up,the effective rates were 98.8%（169 cases） and 88.9%（152 cases）,respectively.The survival rate at 12-month follow up was98.2%（168 cases）.Before treatments,the incidence of PHG were 35.5%,at 3-month of follow up was 38.1%,the difference was not significant（P〉0.05）;the incidence of PHG was 48.0% at 6-month and 84.2% at 1-year of follow up,the differences were statistically significant.Conclusions The endoscopic injection of tissue adhesive to patients with gastric varices can decrease the death rate in acute hemorrhage and increase the survival.However,with the passage of time,the incidence of PHG increased obviously.For improving the life quality and survival of patients with PHG,multiple combination therapies to decrease the incidence of PHG is needed.