食管静脉曲张硬化治疗致食管狭窄的影响因素分析

Influencing factors for esophageal stenosis caused by sclerotherapy for esophageal varices

目的探讨食管静脉曲张硬化治疗致食管狭窄的影响因素。方法收集2011年2月-2016年12月于北京佑安医院行食管静脉曲张硬化治疗致食管狭窄患者17例;同时,选取同期行食管静脉曲张硬化治疗而未发生食管狭窄患者17例作对照。对比分析2组患者硬化剂注射剂量、治疗次数、注射部位等相关因素。计量资料2组间比较采用t检验;计数资料2组间比较采用χ~2检验。结果食管狭窄组患者人均硬化剂治疗次数[(3.11±0.90)次]少于无食管狭窄组[(5.12±2.11)次],差异有统计学意义(t=-3.267,P=0.003)。食管狭窄组次均注射硬化剂量及末次注射硬化剂量均高于无食管狭窄组,差异均有统计学意义[(36.12±3.55)ml vs(28.36±5.08)ml,t=4.046,P<0.001;(19.13±4.19)ml vs(12.46±2.61)ml,t=4.179,P<0.001];且食管狭窄组注射点相邻间距离较近或近似同一平面;反复多次硬化治疗如操作不当易造成食管狭窄。结论科学把握注射剂量、部位及次数,避免溃疡面叠加注射,对预防食管静脉曲张硬化治疗后食管狭窄的发生具有重要的临床意义。

Objective To investigate the influencing factors for esophageal stenosis caused by sclerotherapy for esophageal varices. Methods A retrospective analysis was performed for the clinical data of 17 patients with esophageal stenosis caused by sclerotherapy for esophageal varices who were treated in Beijing You＇an Hospital from February 2011 to December 2016,and 17 patients who were given sclerotherapy for esophageal varices and did not experience esophageal stenosis were enrolled as control group. The two groups were compared in terms of dose of sclerosing agent,number of treatments,injection site,and other related factors. The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. Results The esophageal stenosis group had a significantly lower number of treatments with sclerosing agent than the control group（ 3. 11 ± 0. 90 vs 5. 12 ± 2. 11,t =-3. 267,P = 0. 003）. Compared with the control group,the esophageal stenosis group had significantly higher total dose of sclerosing agent（ 36. 12 ± 3. 55 ml vs 28. 36 ± 5. 08 ml,t = 4. 046,P〈0. 001） and dose of sclerosing agent for last injection（ 19. 13 ± 4. 19 ml vs 12. 46 ±2. 61 ml,t = 4. 179,P〈0. 001）,and the injection sites were close to each other or located on the same plane. Repeated sclerotherapy caused esophageal stenosis in case of improper operation. Conclusion It is of great clinical significance to properly determine injection dose,site,and number of injections and avoid overlap between ulcers,in order to prevent esophageal stenosis after sclerotherapy for esophageal varices.