内镜套扎术分别联合组织溶胶“三明治”注射及聚桂醇注射治疗EVB的效果及安全性对比

Comparison on the effect and safety of endoscopic ligation combined with tissue sol "sandwich" injection and lauromacrogol injection in the treatment of EVB

目的对比内镜套扎术分别联合组织溶胶“三明治”注射及聚桂醇注射治疗食管胃底静脉曲张破裂出血(EVB)的效果及安全性。方法前瞻性选取2021年1月至2022年1月广西医科大学第八附属医院收治的120例EVB患者作为研究对象,按照随机数字表法分为A组和B组,每组各60例。A组采用内镜套扎术联合组织溶胶“三明治”注射治疗,B组采用内镜套扎术联合聚桂醇注射治疗。比较两组手术情况(止血时间、术中出血率和病死率),术前、术后7 d血流动力学指标(血流速度、血流量、内径),术前、术后7 d血清指标[血红蛋白、白细胞计数(WBC)、血小板计数(PLT)],术后1、3、6、12个月静脉曲张复发率以及术后并发症发生情况。结果A组止血时间为(12.63±2.33)min,短于B组[(14.08±2.94)min],术中出血发生率为1.67%,低于B组(13.33%),差异均有统计学意义(P<0.05);两组病死率比较,差异无统计学意义(P>0.05)。术后7 d,两组的血流速度、血流量均较术前升高,且A组的血流速度、血流量分别为(26.91±2.88)cm/s、(884.91±119.29)mL/min,均高于B组[(25.12±2.64)cm/s、(823.60±102.44)mL/min],差异均有统计学意义(P<0.05)。术后7 d,两组的血红蛋白、PLT水平均较术前升高,WBC较术前降低,差异均有统计学意义(P<0.05);但术后7 d,两组血红蛋白、WBC、PLT水平比较,差异均无统计学意义(P>0.05)。术后12个月,A组静脉曲张复发率为5.00%,低于B组(18.33%),差异有统计学意义(P<0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论相较于内镜套扎术联合聚桂醇注射,内镜套扎术联合组织溶胶“三明治”注射治疗EVB患者的效果较好,可有效缩短止血时间,改善门静脉血流动力学,降低静脉曲张复发率,且安全性较好。

Objective To compare the effect and safety of endoscopic ligation combined with tissue sol"sandwich"injection and lauromacrogol injection in the treatment of esophagogastric variceal bleeding(EVB).Methods A total of 120 patients with EVB admitted to the Eighth Affiliated Hospital of Guangxi Medical University from January 2021 and January 2022 were enrolled as the research objects.According to random number table method,they were divided into group A and group B,60 cases in each group.The group A was treated with endoscopic ligation combined with tissue sol"sandwich"injection,and group B was treated with endoscopic ligation combined with lauromacrogol injection.The surgical conditions(hemostasis time,intraoperative bleeding rate,mortality),hemodynamic indexes(blood velocity,blood flow,internal diameter)and serum indexes[hemoglobin,white blood cells(WBC),platelets(PLT)]before and at 7 d after surgery,recurrence rate of varicosity and occurrence of postoperative complications at 1,3,6 and 12 months after surgery were compared between the two groups.Results The hemostatic time in group A was(12.63±2.33)minutes,which was shorter than that in group B[(14.08±2.94)minutes],the incidence of intraoperative bleeding was 1.67%,which was lower than that in group B(13.33%),and the differences were statistically significant(P<0.05);there was no statistically significant difference in mortality between the two groups(P>0.05).At 7 d after surgery,the blood flow velocity and blood flow in two groups were higher than those before surgery,and the blood flow velocity and blood flow in group A were(26.91±2.88)cm/s and(884.91±119.29)mL/min,respectively,which were higher than those in group B[(25.12±2.64)cm/s and(823.60±102.44)mL/min],and the differences were statistically significant(P<0.05).At 7 d after surgery,the levels of hemoglobin and PLT in two groups were higher than those before surgery,while WBC were lower than those before surgery,and the differences were statistically significant(P<0.05);however,there were no statistically significant differences in hemoglobin,WBC,and PLT levels at 7 d after surgery between the two groups(P>0.05).At 12 months after surgery,the recurrence rate of varicosity in group A was 5.00%,which was lower than that in group B(18.33%),and the difference was statistically significant(P<0.05).There was no statistically significant difference in postoperative complications between the two groups(P>0.05).Conclusion Compared with endoscopic ligation combined with lauromacrogol injection,endoscopic ligation combined with tissue sol sandwich injection has better curative effect in EVB patients,which can effectively shorten hemostasis time,improve portal hemodynamics and reduce the recurrence rate of varicosity,with good safety.