内镜下组织胶注射与外科断流术治疗肝硬化胃底静脉曲张疗效对比

Clinical efficacy of endoscopic histoacryl injection vs surgical portal devascularization as a treatment for gastric varices in hepatic cirrhosis

目的:比较内镜下组织胶注射与外科断流术治疗肝硬化胃底静脉曲张的临床效果。方法:选取2010年1月至2015年6月收治的60例肝硬化并重度胃底静脉曲张患者作为研究对象,其中研究组(30例)接受内镜下组织胶注射治疗,对照组(30例)接受外科断流术治疗。术后随访1年,对比两组患者住院时间、住院费用、胃底静脉消除率、手术并发症发生率和术后再出血率。结果:研究组住院时间、治疗费用分别为(9.75±3.19)d和(2.42±0.49)万元,低于对照组的(18.38±5.46)d和(4.85±0.86)万元(P<0.05)。研究组和对照组术后半年胃底静脉完全消除率分别为76.7%(23/30)和70.0%(21/30),两组比较,差异无统计学意义(P>0.05)。研究组和对照组手术相关并发症发生率、术后1年再出血率分别为6.7%、3.3%和10.0%、3.3%,两组比较,差异均无统计学意义(P>0.05)。结论:内镜下组织胶注射与外科断流术均是治疗肝硬化重度胃底静脉曲张安全有效的方法,其中内镜下组织胶注射具有恢复快、费用低等优势。

Objective：To compare the clinical efficacy between endoscopic histoacryl injection and surgical portal devascularization as a treatment for gastric varices （GV） in hepatic cirrhosis. Methods ： Sixty patients with hepatic cirrhosis and severe GV treated between January 2010 and June 2015 were recruited.The study group （ n = 30） received endoscopic injection of histoac,71, while the control group （ n = 30） underwent surgical portal devascularization.The patients were followed up for 1 year after surgery.The length of hospital stay, hospitalization expense ,elimination of varicose vein at the gastric fundus, surgical complications and postoperative rebleeding were compared between the groups. Results ：The length of hospital stay and hospitalization expense were （9.75 ± 3.19） d and （24.2 ±4.9） thousand Yuan,respectively,which were lower than （18.38±5.46） d and （48.5±8.6） thousand Yuan in the control group （ P 〈 0. 05 ）. At 6 mo after surgery, varicose vein at the gastric fundus was completely eliminated in 76.7% （23/30） and 70.0% （21/30） of the patients,respectively,with no significant difference between the two groups （P 〉 0.05 ）. The incidence of surgical complications and the 1-year rate of rebleeding were 6.7% and 3.3%, respectively,in the study group, compared with 10.0% and 3.3%, respectively, in the control group.There were no significant differences in these aspects between the two groups （P〉0.05）. Conclusion：Endoscopic histoacryl injection and surgical portal devascularization are safe and effective treatments for severe gastric varices in patients with hepatic cirrhosis.Endoscopic injection of histoacryl may be advantageous in terms of quicker recovery and lower cost.