大容量套扎器套扎与组织胶联合聚桂醇注射治疗GOV型胃底静脉曲张的比较研究

A comparative study of the treatment of GOV type gastric varices with large-volume band ligators and tissue glue combined with lauromacrogol injection

目的比较大容量套扎器与组织胶注射治疗食管胃静脉曲张(GOV)型胃静脉曲张的疗效和安全性,为GOV型胃静脉曲张的治疗提供参考。方法前瞻性纳入150例GOV型胃静脉曲张患者。结合患者病情及意愿将患者分为内镜下曲张静脉套扎术(EBL组,78例)和内镜下曲张静脉栓塞术(EVO组,72例)。EBL组采用大容量套扎器对GOV型胃静脉曲张进行内镜下套扎治疗;EVO组使用组织胶联合聚桂醇注射治疗。所有患者于首次术后2~3周复查胃镜,观察有无曲张静脉残留及出血(若有,此次随访时需再次治疗)。分别于术后1、3、6个月进行胃镜检查,评估内镜治疗后主要观察指标:曲张静脉止血成功率、技术成功率、根除率、复发率;次要指标(相关并发症):内镜治疗相关出血、发热、败血症和远处栓塞。结果EBL组和EVO组技术成功率、止血成功率、平均治疗次数、胃底静脉曲张根除率差异无统计学意义。EVO组复发率高于EBL组(P<0.05)。EBL组内镜治疗相关出血率低于EVO组,发热率低于EVO组(P<0.05);EVO组中1例患者在注射后发生肺栓塞,3例患者出现败血症。结论大容量套扎器与内镜下注射组织胶根除GOV型胃静脉曲张的短期疗效相似,但前者安全性优于后者。

Objective To compare the efficacy and safety of large volume ligation device and tissue glue injection in the treatment of GOV gastric varicose veins,and to provide reference for the treatment of GOV gastric varicose veins.Methods A total of 150 patients with GOV type gastric varicose veins were prospectively included.Patients were divided into the endoscopic varicose vein ligation(EBL)group(78 cases)and the endoscopic varicose vein embolization(EVO)group(72 cases)according to their condition and willingness.In EBL group,GOV type gastric varices were treated by endoscopic ligation with a large volume ligation device.The EVO group was treated with tissue glue combined with cinnamyl alcohol injection.All patients were re-examined with gastroscopy 2-3 weeks after the first operation to observe whether varicose veins were residual and bleeding(if so,treatment should be repeated at this follow-up visit).Gastroscopy was performed at 1,3 and 6 months after surgery to evaluate the main outcome measures after endoscopic treatment,including success rate of varicose vein hemostasis,technical success rate,eradication rate,recurrence rate and related complications(secondary indicators):endoscopy-related bleeding,fever,sepsis and distant embolization.Results There were no significant differences in technical success rate,hemostasis success rate,average treatment times and 6-month eradication rate of gastric varices between the EBL group and the EVO group.The recurrence rate was higher in the EVO group than that of EBL group(P<0.05).The endoscopy-related bleeding rate and fever rate were lower in the EBL group than those in the EVO group(P<0.05).In the EVO group,1 patient developed pulmonary embolism after injection and 3 patients developed septicemia.Conclusion The short-term efficacy of high volume ligation device is similar to that of endoscopic injection of tissue glue in eradicating GOV gastric varices,but the former is safer than the latter.