食管胃静脉曲张出血内镜下二级预防术后使用生长抑素预防再出血的研究

Study on Use of Somatostatin in Prevention of Rebleeding After Endoscopic Secondary Prevention of Esophago⁃gastric Variceal Bleeding

背景:肝硬化并发食管胃静脉曲张患者的血小板低、凝血功能差以及内镜下二级预防治疗操作时损伤曲张静脉等因素可导致消化道出血,目前内镜下二级预防治疗术后是否使用生长抑素及其类似物尚缺乏明确规范。目的:探讨肝硬化合并食管胃静脉曲张出血患者行内镜下二级预防术后使用生长抑素预防再出血的临床价值。方法:回顾性分析本地区2020年9月—2023年8月确诊的肝硬化合并食管胃静脉曲张出血且接受内镜下二级预防治疗(内镜下静脉曲张套扎术、内镜下硬化剂注射术、内镜下氰基丙烯酸酯注射术)的患者的临床资料,并分为A组(常规治疗)和B组(常规治疗+生长抑素)。比较两组的预后转归(再出血率、病死率)、住院时间、住院费用、不良反应、血液指标等。结果:A组、B组患者术后3 d、术后6周再出血率无明显差异(P>0.05),均未出现死亡病例。A组住院时间、住院费用显著低于B组(P<0.05)。A组与B组不良反应发生率相比无明显差异(P>0.05)。A组、B组患者术后6周血红蛋白、血小板、肌酐、肝功能Child分级与术前相比差异无统计学意义(P>0.05),D-二聚体水平显著降低(P<0.05)。结论:对于食管胃静脉曲张出血患者,术前CT检查后根据血流运行特征进行内镜下二级预防手术,术后可以不必使用生长抑素,可提高治疗依从性,减轻患者经济负担。

Background:Gastrointestinal bleeding is caused by factors such as poor platelet,coagulation function,and damage to varicose veins during endoscopic secondary preventive treatment in cirrhotic patients with esophagogastric varices.At present,there is no clear standard for the use of somatostatin and its analogues after endoscopic secondary preventive treatment.Aims:To investigate the clinical value of somatostatin in preventing rebleeding after endoscopic secondary prevention in cirrhotic patients with esophagogastric variceal bleeding.Methods:Clinical data of cirrhotic patients with esophagogastric variceal bleeding underwent endoscopic secondary prevention(endoscopic variceal ligation,endoscopic injection sclerotherapy,endoscopic cyanoacrylate injection)from Sept.2020 to Aug.2023 in this region were retrospectively analyzed.And patients were divided into group A(conventional therapy)and group B(conventional therapy+somatostatin).The prognosis(rebleeding rate,mortality rate),hospital stay,hospitalization cost,adverse reaction and blood indicators of the two groups were compared.Results:There was no significant difference in rebleeding rate 3 days and 6 weeks after surgery between group A and group B(P>0.05),and no death occurred after surgery in the two groups.Hospital stay and hospitalization cost in group A were significantly decreased than those in group B(P<0.05).No significant difference in incidence of adverse reaction was found between the two groups(P>0.05).No significant differences in hemoglobin,platelets,creatinine and liver function Child classification 6 weeks after surgery in group A and group B were found when compared before surgery(P>0.05),while D⁃dimer level was significantly decreased(P<0.05).Conclusions:For patients with esophagogastric variceal bleeding,endoscopic secondary preventive surgery can be performed according to the characteristics of blood flow after preoperative CT examination,and somatostatin can be unnecessary after surgery to improve treatment compliance and reduce the economic burden of patients.