内镜下组织胶“三明治”联合钛夹治疗GOV2型胃底静脉曲张的应用观察

Observation on application of endoscopic tissue glue"sandwich"combined with titanium clip in treatment of GOV2 gastric varices

目的探讨内镜下组织胶“三明治”联合钛夹治疗2型胃底静脉曲张(gastroesophageal varices type 2,GOV2)的应用价值。方法收集于2017年9月—2019年8月间在荔浦市人民医院住院治疗的60例GOV2型胃底静脉曲张患者作为研究对象,根据患者及家属意愿选择治疗方案,并按照治疗方案分为对照组和观察组,每组各30例。其中对照组接受组织胶+聚桂醇“三明治”夹心疗法,观察组接受“三明治”联合钛夹治疗。评估并比较患者近远期的临床疗效,并对比整个随访期间的并发症发生情况。结果所有患者均顺利完成手术,未出现术中不良反应。与对照组相比,观察组患者组织胶用量明显降低(P<0.05)。观察组的近期治疗总有效率为93.33%,明显高于对照组的82.76%(P<0.05)。治疗后6个月随访,所有钛夹均自行脱落。12个月随访时,观察组的远期治疗总有效率为94.00%,明显高于对照组的83.00%(P<0.05)。在整个随访期间,两组患者均未出现术中大出血、异位栓塞、排胶后深溃疡等严重并发症。观察组与对照组腹部不适、发热、腹腔感染等并发症的发生率无明显差异(P>0.05),但再出血的发生率明显降低(P<0.05)。结论内镜下组织胶“三明治”联合钛夹治疗GOV2型胃底静脉曲张能够在一定程度上提高治疗有效率,促进静脉曲张的消除,并且不增加手术风险,也可降低术后并发症发生率。

Objective To explore the application value of endoscopic tissue glue"sandwich"combined with titanium clip in the treatment of GOV2 gastric varices.Methods Sixty patients with GOV2 gastric varices treated in Lipu peo⁃ple's Hospital from September 2017 to August 2019 were selected according to the wishes of the patients and their families,and were divided into the control group and the observation group with 30 patients in each group.The control group received tissue glue and polycinnamol"sandwich"therapy,while the observation group received"sandwich"combined with titanium clip therapy.The short-term and long-term clinical effects of the patients were evaluated and compared,and the incidence of complications during the whole follow-up period were compared.Results All patients operations were completed successfully and there were no intraoperative adverse reactions.Compared with the control group,the amount of tissue glue in the observation group was significantly lower than that in the control group(P<0.05).The total effective rate of short-term treatment in the observation group was 93.33%,which was significantly higher than that in the control group(82.76%)(P<0.05).During the follow-up 6 months after treatment,all titanium clips fell off by themselves.During the 12-month follow-up,.The total effective rate of long-term treatment in the ob⁃servation group was 94.00%,which was significantly higher than that in the control group(83.00%)(P<0.05).During the whole follow-up period,there were no serious complications,ie.intraoperative hemorrhage,ectopic embolism and deep ulcer after glue drainage in both groups.There was no significant difference in the incidence of abdominal dis⁃comfort,fever and abdominal infection between the groups(P>0.05),but the incidence of rebleeding decreased signif⁃icantly(P<0.05).Conclusion Endoscopic tissue glue"sandwich"combined with titanium clip in the treatment of GOV2 gastric varices can increase the effective rate to some extent and promote the elimination of varicose veins.And it does not only decrease the risk of operation,but also can reduce the incidence of postoperative complications,which is worthy of further study.