内镜下应用组织胶注射联合硬化和套扎术序贯治疗食管胃底静脉曲张临床效果探讨

Clinical efficacy of endoscopic TAI combined with EIS and EVL in the sequential treatment of esophageal and gastric varices

【目的】探讨食管胃底静脉曲张患者内镜下应用组织胶注射(tissue adhesive injection,TAI)联合硬化(endoscopic injection sclerotherapy,EIS)-套扎术(endoscopic variceal ligation,EVL)序贯治疗的临床疗效,进一步为临床治疗提供参考依据。【方法】选取我院2015年3月至2017年3月收治的食管胃底静脉曲张患者156例为本次研究对象,选择接受序贯治疗患者作为联合治疗组共78例,并配对选择接受TAI治疗的TAI治疗组。随访24个月,观察患者静脉曲张数目与直径、红色征及门静脉高压性胃病在内镜下的改变以及并发症等情况,Kaplan-Meier法分析两组患者生存情况。【结果】联合治疗组有效率、随访24个月静脉曲张数目与直径、红色征改善情况显著高于TAI治疗组,其并发症发生情况、复发率显著低于TAI治疗组,联合治疗组患者治疗后生存情况优于TAI治疗组(χ~2=4.328,P=0.046),门静脉高压性胃病发生情况无明显统计学意义。【结论】内镜下应用TAI注射联合EIS-EVL序贯治疗食管胃底静脉曲张是一项安全可靠的方法,具有治疗曲张静脉消有效率高、复发率低、并发症少等优点,值得推广应用。

【Objective】To study the clinical efficacy of endoscopic tissue adhesive injection(TAI) combined with endoscopic injection sclerotherapy(EIS) and endoscopic variceal ligation(EVL) in the sequential treatment of esophageal and gastric varicose veins, and provide further reference for clinical treatment.【Methods】A total of 158 cases with esophageal and gastric varicose veins in our hospital were chosen from Mar 2015 to Mar 2017 for this study. Sequential treatment was selected in the combined treatment group with78 cases, and TAI was performed in the TAI treatment group. The number and diameter of varicose veins, red sign, endoscopic changes of portal hypertensive gastropathy and complications were observed in the 24-month follow-up. Survival status of patients in both groups was analyzed by kaplan-Meier method.【Results】The improvement of varicose vein number, diameter and red sign in the combined treatment group was significantly better than that in the TAI treatment group. The complication and relapse rate were significantly lower than those in the TAI treatment group. The survival of patients in the combined treatment group was better than that in the TAI treatment group(χ^2=4.328,P=0.046)). The incidence of portal hypertension was not significant.【Conclusion】The application of endoscopic TAI combined with EIS-EVL sequential treatment for esophageal varicose veins is safe and reliable. It is of the advantages of high efficiency,low recurrence rate, and few complications in the treatment of varicose veins. Therefore, it is worth promoting and applying.