内镜套扎术联合生长抑素治疗肝硬化并发食管静脉曲张出血患者临床效果和安全性分析

Clinical therapeutic efficacy and safety of endoscopic variceal ligation combined with somatostatin in treatment of patients with liver cirrhosis complicated by esophageal variceal bleeding

目的分析采用内镜下曲张静脉套扎术联合生长抑素治疗肝硬化并发食管静脉曲张破裂出血患者的临床治疗效果和安全性。方法 2015年4月～2017年5月我院收治的肝硬化并发食管静脉曲张破裂出血患者64例,被分为两组,每组32例。在对照组,给予奥美拉唑和奥曲肽治疗,观察组则在上述治疗12 h后,给予内镜下曲张静脉套扎术治疗。结果在治疗1 w末,观察组止血总有效率为100.0%,显著高于对照组的90.6%(P<0.05),对照组死亡3例;治疗后,观察组肝静脉压力梯度(HVPG)为(6.5±1.0) mmHg,显著低于对照组的(11.9±1.1)mmHg,而RBC为(4.7±0.5)×10^(12)/L,Hb为(118.5±23.1) g/L,显著高于对照组[分别为(4.1±0.4)×10^(12)/L和(104.4±22.5) g/L,P<0.05];观察组止血时间为(1.3±0.4)d、输血量为(1.7±1.0) U、住院日为(20.4±3.5) d,显著短于或少于对照组[分别为(2.8±0.5) d、(2.8±1.5) U和(29.8±4.0) d,P<0.05];进行为期1年的随访,观察组再出血发生率为53.1%,显著低于对照组的86.2%(P<0.05)。结论针对肝硬化并发食管静脉曲张出血患者,采用内镜套扎术联合生长抑素治疗可有效止血,缩短住院时间,止血迅速,治疗后再出血发生率低,且安全性较高。

Objective To analyze the clinical efficacy and safety of endoscopic variceal ligation(EVL)combined with somatostatin in treatment of patients with liver cirrhosis complicated by esophageal variceal bleeding(EVB).Methods 64 patients with liver cirrhosis complicated by EVB were recruited in our hospital between April 2015 and May 2017,and were divided into two groups receiving somatostatin or somatostatin and EVL.Results At the end of one week treatment,the hemostasis in combination group was 100.0%,significantly higher than 90.6%(P<0.05)in the somatostatin-treated patients,and three patients died in the latter;after treatment,the hepatic nenous pressure gradient(HVPG)in combination group was(6.5±1.0)mmHg,much lower than(11.9±1.1)mmHg in the control,while RBC was(4.7±0.5)×10^12/L,Hb was(118.5±23.1)g/L,significantly higher than(4.1±0.4)×10^12/L and(104.4±22.5)g/L in the control(P<0.05);the hemostasis time was(1.3±0.4)d,blood transfusion was(1.7±1.0)U,and hospital stay was(20.4±3.5)d,significantly shorter or less than(2.8±0.5)d,(2.8±1.5)U and(29.8±4.0)d in the control(P<0.05);at the end of one-year follow-up,the incidences of rebleeding in the two groups were 53.1%and 86.2%(P<0.05).Conclusion The emergent application of somatostatin and EVL in dealing with patients with liver cirrhosis complicated by EVB is efficient and safe,which can effectively achieve rapid hemostasis and shorten the hospitalization time.