内镜下精准断流术治疗食管胃静脉曲张的临床应用

Clinical application of endoscopic selective varices devascularization for esophagogastric varicose

目的探讨食管胃静脉曲张精准断流术与改良“三明治”法治疗食管胃静脉曲张的临床疗效。方法选取共50例食管胃底静脉曲张患者,按随机数字法分为精准治疗组和对照组,精准治疗组(n=25)行内镜下食管胃静脉曲张精准断流术,对照组(n=25)接受改良“三明治”法内镜治疗。分析对比两组的止血成功率、再出血率、治疗显效率、并发症发生率、聚桂醇和组织胶用量、治疗时间及住院天数等指标。结果治疗后随访3个月,术后3天内止血率两组均为100%。再出血率精准治疗组为4%,对照组为32%,差异有统计学意义(P=0.010)。静脉曲张治疗显效率精准治疗组为84%,对照组出血率为52%,差异有统计学意义(P=0.015)。并发症发生率在两组间差异无统计学意义(P>0.05)。聚桂醇和组织胶平均用量在两组间差异无统计学意义(P>0.05)。精准治疗组平均治疗时间为(32.60±6.44)min,对照组为(40.60±7.26)min,差异有统计学意义(P<0.0001);精准治疗组平均住院天数为(8.12±1.24)d,对照组为(9.12±1.39)d,差异有统计学意义(P=0.010)。结论内镜下精准断流术治疗食管胃静脉曲张再出血率低、效果好、安全性高。

Objective To investigate the clinical efficacy of endoscopic selective varices devascularization and the modified Sandwich method on the treatment of esophagogastric varices.Methods 50 patients with esophagogastric varices were divided into therapy(endoscopic selective varices devascularization)group(n=25)and control group(n=25)by random number table method.The therapy group(n=25)received the treatment of endoscopic selective varices devascularization.The control group(n=25)was treated with modified Sandwich method injection.The success rate of hemostasis,rate of recurrent bleeding,rate of varices disappearance,complication rate,dosage of lauromacrogol and tissue adhesive,time of therapy and hospitalization days were compared and analyzed between the two groups.Results During the 3-month followup,the success rates of hemostasis were 100%in both groups 3 days after the treatments.The rates of recurrent bleeding in therapy group and control group were 4%and 32%respectively,with statistically significant difference(P=0.010).The rates of varices disappearance in therapy group and control group were 84%and 52%respectively,the difference(P=0.015)was statistically significant.There was no statistically significant difference in complication rates between the two groups(P>0.05).There was also no statistically significant difference in the average dosage of lauromacrogol and tissue adhesive between the two groups(P>0.05).The average time of therapy in therapy group and control group were(32.60±6.44)minutes and(40.60±7.26)minutes respectively,with statistically significant difference between the two groups(P=0.000).The average hospitalization days in therapy group and control group were(8.12±1.24)days and(9.12±1.39)days respectively,which is statistically significant difference between the two groups(P=0.010).Conclusion Endoscopic selective varices devascularization has the obvious advantage of a significant efficacy,low recurrence rate and high safety.