内镜下硬化剂联合组织粘合剂治疗肝硬化食管胃底静脉曲张破裂出血的临床疗效

Clinical analysis of endoscopic sclerotherapy combined with tissue adhesive in the treatment of cirrhosis with esophagogastric variceal bleeding

目的探究内镜下硬化剂联合组织粘合剂对肝硬化食管胃底静脉曲张破裂出血的临床疗效。方法对青海省中医院121例内镜治疗的肝硬化食管胃底静脉曲张破裂出血的病例资料进行回顾性分析,其中食管静脉曲张破裂出血行硬化剂治疗而胃底静脉曲张破裂出血行组织粘合剂治疗的患者共60例,作为单一组;食管、胃底静脉曲张破裂出血均行硬化剂联合组织粘合剂治疗的患者共61例,作为联合组。对比分析两组患者治疗的有效率、并发症发生率、静脉曲张消除情况及再出血率。结果治疗后,联合组有效率为80.3%,显著高于单一组的61.7%(P <0.05)。单一组术中出血的发生率显著高于联合组(P <0.05)。联合组首次治疗静脉曲张消除率为77.0%,显著高于单一组的58.3%(P <0.05)。单一组术后6个月内的再出血率显著高于联合组(P <0.05)。结论内镜下硬化剂联合组织粘合剂在治疗肝硬化食管胃底静脉曲张破裂出血中具有较好的疗效和安全性,值得临床推广应用。

Objective To investigate the clinical efficacy of endoscopic sclerotherapy combined with tissue adhesive in the treatment of esophageal and gastric varices bleeding due to cirrhosis. Methods A retrospective analysis was performed on the clinical data of 121 cirrhotic patients with esophageal and gastric varices bleeding in Qinghai Traditional Chinese Medicine Hospital. The patients were divided into combined group（61 cases） and single group （60 cases） according to the treatment methods. Sclerosing agent was used to treat esophageal variceal bleeding and tissue adhesive was used to treat gastric variceal bleeding in single group. Sclerosing agent combined with tissue adhesive was used to treat esophageal and gastric variceal bleeding in combined group. The efficacy, incidence of complications and elimination of varicose veins were compared between single group and combined group. Results After treatment, the effective rate of the combined group was 80.3%, significantly higher than that of the single group （61.7%） （P 〈 0.05）. The incidence of bleeding in the single group was significantly higher than that in the combined group （P 〈 0.05）. The elimination rate of varicose in the combined group was 77%, which was significantly higher than that in the single group （58.3%）（P 〈 0.05）. The rebleeding rate in the single group within 6 months after operation was significantly higher than that in the combined group （P 〈 0.05）.Conclusion Endoscopic sclerosing agent combined with tissue adhesive has good efficacy and safety in the treatment of the esophagogastric variceal bleeding in cirrhotic patients. It is worthy of clinical application.