不同方法治疗肝硬化食管胃静脉曲张破裂出血临床疗效比较

Comparison of the clinical effects of different methods in the treatment of esophagogastric variceal bleeding of liver cirrhosis

目的探讨不同方法治疗肝硬化食管胃静脉曲张破裂出血的临床疗效。方法选择2015年1月—2019年1月在河北工程大学附属医院治疗的肝硬化食管胃静脉曲张破裂出血患者150例,根据治疗方法不同分为内镜治疗组78例、介入治疗组46例、外科手术组26例,比较3组患者的止血效果、再出血率、病死率、住院时间、住院费用,检测3组治疗前及治疗1周后尾加压素Ⅱ、血管活性肠肽水平,随访3个月静脉曲张复发率。结果3组急性期止血成功率、早期再出血率比较差异均无统计学意义(P均>0.05);内镜治疗组、介入治疗组和外科手术组晚期再出血率分别为5.1%(4/78)、19.6%(9/46)、7.7%(2/26),内镜治疗组、外科手术组均明显低于介入手术组(P均<0.05),内镜治疗组与外科手术组比较差异无统计学意义(P>0.05);内镜治疗组、介入治疗组和外科手术组术后1个月病死率分别为2.6%(2/78)、4.3%(2/46)、15.4%(4/26),内镜治疗组与介入治疗组均明显低于外科手术组(P均<0.05),内镜治疗组与介入治疗组比较差异无统计学意义(P>0.05);内镜治疗组住院时间明显短于介入治疗组与外科手术组(P均<0.05),住院费用明显少于介入治疗组与外科手术组(P均<0.05),介入治疗组与外科手术组比较差异均无统计学意义(P均>0.05);治疗后内镜治疗组及介入治疗组尾加压素Ⅱ、血管活性肠肽水平和外科手术组血管活性肠肽水平均无明显变化(P均>0.05),但外科手术组治疗后尾加压素Ⅱ水平明显低于治疗前及其他组(P均<0.05)。随访3个月,3组静脉曲张复发率比较差异均无统计学意义(P均>0.05)。结论内镜治疗肝硬化食管胃静脉曲张破裂出血患者效果优于外科手术治疗及介入治疗。

Objective It is to explore the clinical effects of different methods in the treatment of esophagogastric variceal bleeding of liver cirrhosis.Methods A total of 150 patients with esophagogastric variceal bleeding of liver cirrhosis treated in the Affiliated Hospital of Hebei University of Engineering from January 2015 to January 2019 were collected and divided into endoscopic treatment group(78 cases),interventional treatment group(46 cases)and surgical operation group(46 cases)according to their treatment methods.The hemostatic effect,rebleeding rate,fatality rate,hospitalization time,and hospitalization expenses of the three groups were compared.The levels of urotensin II and vasoactive intestinal peptide were measured before treatment and 1 week after treatment in the three groups.Varicose vein recurrence rate in 3 months was followed up.Results There was no significant difference in the hemostatic success rate at acute stage and early rebleeding rate among the three groups(all P>0.05);the late rebleeding rate of the endoscopic treatment group,interventional treatment group and surgical group respectively was 5.1%(4/78),19.6%(9/46),7.7%(2/26),the rate in the endoscopic treatment group and the surgical operation group were significantly lower than that in the interventional operation group(P<0.05),but the difference was not statistically significant between endoscopic treatment group and surgical operation group(P>0.05);the mortality rate in one month after operation in the endoscopic treatment group,interventional treatment group and surgical operation group respectively was 2.6%(2/78),4.3%(2/46),15.4%(4/26),the rate in the endoscopic treatment group and the interventional treatment group were significantly lower than that in the surgical group(P<0.05),there was no significant difference in the rate between the endoscopic treatment group and the interventional treatment group(P>0.05).The hospital stay in the endoscopic treatment group was significantly shorter than that of the interventional treatment group and the surgical operation group(both P<0.05),and the hospitalization expenses were significantly less than that of the interventional treatment group and the surgical operation group(both P<0.05),but the difference between the interventional treatment group and the surgical operation group was both not statistically significant(all P>0.05).After treatment,the levels of urotensin II and vasoactive intestinal peptide in the endoscopic treatment group and the interventional treatment group and the levels of vasoactive intestinal peptide in the surgical group did not change significantly(all P>0.05),but the level of urotensin II after treatment in the surgical group was significantly lower than that before treatment and in other groups(P<0.05).After 3 months of follow-up,there was no significant difference in the recurrence rate of varicose veins in the three groups(all P>0.05).Conclusion Endoscopic treatment is better than surgical treatment and interventional treatment in the treatment of patients with esophagogastric variceal bleeding of liver cirrhosis.