经内镜套扎术与组织黏合剂联合硬化剂注射术治疗肝硬化食管胃底静脉曲张的临床研究

Clinical study on endoscopic varices ligation and tissue adhesive combined with sclerosing agent injection in the treatment of esophageal and gastric varices in cirrhosis

目的:探讨经内镜套扎术与组织黏合剂联合硬化剂注射术治疗肝硬化食管胃底静脉曲张的临床疗效。方法:选取进行食管胃底静脉曲张治疗的病人83例,随机分为2组,经内镜食管胃底静脉曲张套扎术治疗42例(EVL组),经内镜组织黏合剂联合硬化注射治疗41例(联合组),分别观察2组病人治疗后短期并发症,1、6个月复查胃镜观察治疗后食管胃底静脉曲张减轻程度。结果:联合组吞咽哽阻感、局部溃疡发生率高于EVL组,咽喉部痛疼发生率低于EVL组,差异均有统计学意义(P<0.05),发热、近期出血、胸痛发生率2组差异无统计学意义(P>0.05);1个月复查胃镜,联合组食管胃底静脉曲张改善的总有效率为80.5%,EVL组改善率为85.7%,差异无统计学意义(P>0.05);6个月复查胃镜,联合组食管胃底静脉曲张改善的总有效率为87.9%高于EVL组的69.1%(P<0.05)。结论:经内镜套扎术和组织黏合剂联合硬化剂注射术均可有效减轻食管胃底静脉曲张程度,经内镜组织黏合剂联合硬化剂注射术长期疗效优于套扎治疗术。

Objective:To evaluate the clinical curative effects of endoscopic varices ligation(EVL)and tissue adhesive combined with sclerosing agent injection in the treatment of esophageal and gastric varices in patients with cirrhosis.Methods:Eighty-three patients treated with esophageal and gastric varices were selected,and divided into the EVL group(42 cases treated with endoscopic varices ligation),and combined group(41 cases treated with tissue adhesive combined with sclerosing agent injection).The short-term complications in two groups after treatment were observed,and the reduction of esophageal and gastric varices after 1 and 6 months of treatment was reexamined using gastroscopy.Results:The incidence rates of choking sensation and local ulcer in combined group were higher than those in EVL group,and the incidence rate of throat pain in combined group was lower than that in EVL group(P<0.05).The differences of the incidence rates of fever,recent bleeding and chest pain were not statistically significant between two groups(P>0.05).The results of the gastroscopy reexamination after 1 month showed that the total effective rates of improvement of the varices of esophagus and stomach fundus in the combined group and EVL group were 80.5%and 85.7%,respectively,and the difference of which was not statistically significant(P>0.05).The results of the gastroscopy reexamination after 6 months showed that the total effective rates of improvement of the varices of esophagus and stomach fundus in the combined group and EVL group were 87.9%and 69.1%,respectively,and the difference of which was statistically significant(P<0.05).Conclusions:The endoscopic varices ligation and tissue adhesive combined with sclerosing agent injection can effectively alleviate the esophageal and gastric varices.The long-term therapeutic effect of tissue adhesive combined with sclerosing agent injection is superior to endoscopic varices ligation.