内镜下套扎术联合硬化剂和组织黏合剂注射治疗对食管胃底静脉曲张破裂出血的效果

Effect of endoscopic ligation combined with injection of sclerosant and tissue adhesive on rupture and bleeding of esophagogastric varices

目的观察内镜下套扎术联合硬化剂和组织黏合剂注射治疗对食管胃底静脉曲张破裂出血的效果。方法收集2019年6月至2022年5月于新疆医科大学第一附属医院接受内镜下治疗的118例食管胃底静脉曲张破裂出血患者的临床资料。观察患者的临床疗效(急性期止血成功率)、术后3个月食管胃底静脉曲张改善率、安全性指标(并发症发生率),以及随访期间(治疗结束后3个月内)的再出血率、全因死亡率。结果118例食管胃底静脉曲张破裂出血患者中,24例患者接受急诊内镜治疗。所有患者均成功止血,急性期止血成功率为100%。术后3个月内复查胃镜,显效47例,有效58例,食管胃底静脉曲张改善的总有效率为89.0%(105/118),内镜治疗过程中并发症总发生率为28.8%(34/118),其中,胸痛患者11例,发热患者6例,咽喉疼痛患者13例,恶心呕吐患者4例。随访期间,全因死亡患者3例,再出血患者12例。结论对于食管胃底静脉曲张破裂出血患者,内镜下套扎术联合硬化剂和组织黏合剂注射治疗的即刻成功率高,短期随访效果较好,安全性较高,值得临床推广。

Objective To observe the effect of endoscopic ligation combined with injection of sclerosant and tissue adhesive on rupture and bleeding of esophagogastric varices.Method The clinical data of 118 patients with ruptured and bleeding esophagogastric varices who received endoscopic treatment in the First Affiliated Hospital of Xinjiang Medical University from June 2019 to May 2022 were collected.The clinical efficacy(success rate of hemostasis in the acute phase),the improvement rate of esophagogastric varices 3 months after the operation,the safety index(complication rate),and rebleeding during the follow-up period(within 3 months after the end of treatment)and all-cause mortality were observed.Result Among all 118 patients with esophageal and gastric varices rupture and bleeding,24 patients underwent emergency endoscopic treatment.Hemostasis was successfully achieved in all patients,and the success rate of hemostasis in the acute phase was 100%.Re-examination of gastroscopy within 3 months after the operation showed that 47 cases were markedly effective and 58 cases were effective.The total effective rate of improvement of esophageal and gastric varices was 89.0%(105/118),the overall incidence of complications during endoscopic treatment was 28.8%(34/118)in all patients with rupture and bleeding of esophagogastric varices,among them,there were 11 patients with chest pain,6 patients with fever,13 patients with sore throat,and 4 patients with nausea and vomiting.During the follow-up period,3 patients died of all causes and 12 patients suffered from re-bleeding.Conclusion Endoscopic ligation combined with sclerosant and tissue adhesive injection in the treatment of rupture and bleeding of esophagogastric varices has a high immediate success rate,good short-term follow-up effect with high safety,which is worthy of clinical promotion.