内镜下套扎序贯硬化剂治疗肝硬化并食管胃底静脉曲张破裂出血的效果

Therapeutic effect of endoscopic ligation and sequential sclerotherapy on liver cirrhosis complicated by esophageal and gastric variceal bleeding

目的探讨内镜下套扎序贯硬化剂治疗肝硬化并食管胃底静脉曲张破裂出血(EGVB)的效果。方法队列研究。抽取2021年1月至2023年1月咸阳市中心医院收治的108例肝硬化并EGVB患者,按随机数字表法分为对照组和观察组,每组54例。对照组行内镜下套扎治疗,观察组行内镜下套扎序贯硬化剂治疗。比较两组的止血效果、门静脉血流动力学指标[门静脉压(PVP)、门静脉血流量(PVF)、门静脉血流速度(PVV)及门静脉内径(PVD)]、血清胃肠激素(胃动素、胃泌素)水平及再出血率。结果观察组止血总有效率(96.30%,52/54)高于对照组(85.19%,46/54),P<0.05。治疗后,观察组PVP、PVF、PVV、PVD均低于对照组(P均<0.05)。治疗后,观察组胃动素、胃泌素水平低于对照组(P<0.05)。观察组再出血率(3.70%,2/54)低于对照组(16.67%,9/54),P<0.05。结论内镜下套扎序贯硬化剂治疗对肝硬化并EGVB有较好的止血效果,可改善门静脉血流动力学指标,降低胃肠激素水平,且再出血率低。

Objective To investigate the application effect of endoscopic ligation and sequential sclerotherapy in the treatment of esophageal and gastric variceal bleeding(EGVB)in patients with liver cirrhosis.Methods A total of 108 patients with liver cirrhosis complicated by EGVB admitted to Xianyang Central Hospital from January 2021 to January 2023 were selected for the Cohort trail.And they were divided into control group and observation group by random number table method,with 54 cases in each group.The control group received endoscopic ligation treatment,while the observation group received endoscopic ligation and sequential sclerotherapy.The hemostatic effect,portal vein hemodynamics,including portal vein pressure(PVP),portal vein blood flow(PVF),portal vein blood flow velocity(PVV)and portal vein diameter(PVD),serum levels of gastrointestinal hormones(motilin and gastrin),and rebleeding rate were compared between the two groups.Results The hemostatic effect of the observation group(96.30%,52/54)was higher than that of the control group(85.19%,46/54),P<0.05.After treatment,the PVP,PVF,PVV and PVD of the observation group were lower than those of the control group(all P<0.05).After treatment,the levels of motilin and gastrin of the observation group were lower than those of the control group(P<0.05).The rebleeding rate of the observation group(3.70%,2/54)was lower than that of the control group(16.67%,9/54),P<0.05.Conclusions Endoscopic ligation and sequential sclerotherapy can improve the hemostatic effect of EGVB in patients with liver cirrhosis,correct portal vein hemodynamics,reduce levels of gastrointestinal hormones,and have a low rate of rebleeding.