不同时机内镜下食管胃底静脉曲张精准断流术联合内镜下硬化术治疗食管胃底静脉曲张破裂出血的临床效果

Clinical effect of endoscopic selective varies devascularization combined with endoscopic injection sclerotherapy at different timings in the treatment of esophageal and gastric varices bleeding

目的探讨不同时机内镜下食管胃底静脉曲张精准断流术(ESVD)联合内镜下硬化术(EIS)治疗食管胃底静脉曲张破裂出血的临床效果与安全性。方法回顾性分析2020年7月至2021年6月于九江市第一人民医院治疗的60例肝硬化合并食管胃底静脉曲张破裂出血患者的临床资料,所有患者均行ESVD联合EIS治疗,将其中于发病后6~<12 h进行治疗的32例患者纳入A组,将于发病后12~24 h进行治疗的28例患者纳入B组,所有患者术后均随访1年。比较两组患者治疗后3个月的临床疗效、两组患者随访期间再出血率(早期再出血率、迟发性再出血率、总再出血率)以及术后并发症发生率。结果治疗后3个月A组的临床疗效高于B组,差异有统计学意义(P<0.05);随访期间A组的总再出血率低于B组,差异有统计学意义(P<0.05);术后两组患者的并发症发生率比较,差异均无统计学意义(P>0.05)。结论对于食管胃底静脉曲张破裂出血患者,于发病后早期采取ESVD联合EIS手术方案的临床疗效显著,能降低患者的总再出血率,且安全性良好。

Objective To explore the clinical efficacy and safety of endoscopic selective varies devascularization(ESVD)combined with endoscopic injection sclerotherapy(EIS)at different timings in the treatment of esophageal and gastric varices bleeding.Methods From July 2020 to June 2021,the clinical data of 60 patients with liver cirrhosis complicated with esophageal and gastric varices bleeding treated in the Jiujiang No.1 People's Hospital were analyzed by regression analysis,All patients were treated with ESVD combined with EIS.Among them,32 patients who were treated 6-<12 hours after the onset of disease were included in Group A,and 28 patients who were treated 12-24 hours after the onset of disease were included in Group B,and all patients were followed up for 1 year after surgery.The clinical efficacy of the two groups of patients at 3 months after treatment,the rate of re-bleeding(early re-bleeding rate,delayed re-bleeding rate,total re-bleeding rate)during follow-up and the rate of postoperative complications were compared between the two groups.Results The clinical efficacy of group A at 3 months after treatment was higher than that of group B,the difference was statistically significant(P<0.05).The total re-bleeding rate of group A during follow-up was lower than that of group B,the difference was statistically significant(P<0.05).There were no statistical differences in the incidence rates of complications between the two groups after surgery(P>0.05).Conclusion For patients with esophageal and gastric varices bleeding,ESVD combined with EIS in the early stage after the onset of the disease has a significant clinical efficacy,and it can reduce the total re-bleeding rate,and has good safety.