CT门脉成像联合内镜超声指导肝硬化食管胃底静脉曲张精准治疗的随机对照研究

A randomized controlled study of CT portograph combined with endoscopic ultrasonography for the precision treatment of esophagogastric varices in patients with cirrhosis

目的探讨CT门脉成像联合内镜超声指导下肝硬化食管胃底静脉曲张精准治疗的疗效及安全性。方法选择2013年1月至2015年1月间因肝硬化合并食管胃底静脉曲张破裂出血并行内镜下治疗的住院患者共130例，采用前瞻性随机对照试验方法，用数字表法将患者随机分为试验组及对照组各65例。试验组患者用CT门脉成像评估食管胃底曲张静脉的数量和静脉曲张的程度，再行内镜下治疗；第二次治疗前行超声内镜检查评估食管旁及穿支静脉情况，再治疗。对照组直接进镜观察食管胃底静脉曲张范围及程度，根据经验行内镜下治疗。结果试验组最终完成治疗及随访的患者共62例，对照组63例。平均治疗次数试验组明显少于对照组（3．00±0．76比5．63±0．92，P=0．000），静脉曲张消失时间试验组明显短于对照组[（7．25±1．16）个月比（8．88±1．64）个月，P=0．039]。静脉曲张复发率试验组明显低于对照组[1．6％（1／62）比12．7％（8／63），P=0．040]。胸腔积液发生率试验组明显低于对照组[0（0／62）比9．5％（6／63），P：0．040]。总体并发症发生率试验组明显低于对照组[27．4％（17／62）比58．7％（37／63），P=0．003]。结论CT门静脉成像联合内镜超声指导治疗肝硬化食管胃底静脉曲张安全有效。

Objective To investigate the efficacy and safety of CT portograph combined with endoscopic uhrasonography for the pricision treatment of esophagogastric varices in patients with cirrhosis. Methods A total of 130 inpatients with cirrhosis complicated with esophagogastric variceal bleeding who received endoscopic treatment from January 2013 to January 2015 were selected. Using prospective randomized controlled design, the patients were divided into two groups, the experimental group and the control group, with 65 cases in each group. The number and degree of esophagogastric variees were assessed by CT portography in the experimental group. Then endoscopic ultrasonography was used to assess the paraesophageal vein and perforator vein before endoscopic treatment. The range and degree of esophagogastric varices were observed and the lesions were treated by endoscopy in the control group. Results A total of 62 patients completed the study in the experimental group, and 63 in the control group. The number of treatment was significantly lower in the experimental group than that in the control group（ 3.00±0. 76 VS 5.63±0. 92, P = 0. 000）. The disappearance time of varices was significantly shorter in the experimental group than that in the control group（7.25±1.16 months VS 8.88±1.64 months, P= 0. 039）. The variceal recurrence rate of the experimental group was significantly lower than that of the control group [ 1.6% （1/62） VS 12. 7% （8/63） , P= 0. 040]. The incidence of pleural effusion was significantly lower in the experimental group than that in the control group [ 0 （ 0/62 ） VS 9. 5% （ 6/63 ）, P = 0. 040 ]. The total complication rate was significantly lower in the experimental group than that in the control group[ 27.4% （17/62） VS 58.7% （ 37/63）, P = 0. 003 ]. Conclusion CT portography combined with endoscopic ultrasonography is safe and effective for esophageal gastric varices in patients with cirrhosis.