内镜下改良“三明治夹心法”对重度食管静脉曲张的治疗效果及对早期再出血的影响

The effect of improved"sandwich method"under endoscope in the treatment of severe esophageal varices and its influence on early rebleeding

目的探讨内镜下改良“三明治夹心法”对重度食管静脉曲张(esophageal varices,EV)的治疗效果及对早期再出血的影响。方法选取2018年4月至2021年4月新余市人民医院收治的60例重度EV患者作为研究对象,采用摸球法分为对照组与观察组,每组30例。对照组采用“三明治夹心法”(聚桂醇+组织胶+聚桂醇)治疗,观察组采用改良“三明治夹心法”(0.9%氯化钠溶液+组织胶+0.9%氯化钠溶液)治疗。比较两组临床疗效、症状积分、生命质量综合评定问卷(generic quality of life inventory-74,GQOLI-74)评分、复发率、出血率及并发症发生率。结果观察组治疗总有效率为96.67%,高于对照组的73.33%,差异有统计学意义(P<0.05);治疗后,观察组腹胀、恶心、食欲减退、呕吐评分均低于对照组,躯体功能、心理功能、社会功能、物质生活状态评分均高于对照组,差异有统计学意义(P<0.05);治疗后随访1年,观察组再出血率、复发率均为3.33%,均低于对照组的33.33%、30.00%,差异有统计学意义(P<0.05);治疗后6个月,观察组并发症发生率为6.67%,低于对照组的33.33%,差异有统计学意义(P<0.05)。结论采用改良“三明治夹心法”治疗重度EV患者效果显著,能有效降低患者复发率和出血率,减少并发症的发生,提高患者生命质量,改善患者临床不良症状。

Objective To explore the effect of improved"sandwich method"under endoscope in the treatment of severe esophageal varices(EV)and its influence on early rebleeding.Methods 60 patients with severe EV treated in Xinyu People's Hospital from April 2018 to April 2021 were selected as the research subjects,and they were divided into the control group and the observation group by touch ball method,with 30 cases in each group.The control group was treated with"sandwich method"(lauryl alcohol+tissue glue+lauryl alcohol),and the observation group was treated with improved"sandwich method"(0.9%sodium chloride+tissue glue+0.9%sodium chloride).The clinical efficacy,symptom score,generic quality of life inventory-74(GQOLI-74)score,recurrence rate,bleeding rate and complication rate were compared between the two groups.Results The total effective rate in the observation group was 96.67%,which was higher than 73.33%in the control group,and the difference was statistically significant(P<0.05);after treatment,the scores of abdominal distension,nausea,loss of appetite and vomiting in the observation group were lower than those in the control group,and the scores of physical function,psychological function,social function and material life status were higher than those in the control group,and the differences were statistically significant(P<0.05);after 1 year of follow-up after treatment,the rebleeding rate and recurrence rate in the observation group all were 3.33%,which were lower than 33.33%and 30.00%in the control group,and the differences were statistically significant(P<0.05).6 months after treatment,the incidence of complications in the observation group was 6.67%,which was lower than 33.33%in the control group,and the difference was statistically significant(P<0.05).Conclusion The improved"sandwich method"in the treatment of severe EV patients is effective,which can effectively reduce the recurrence rate,bleeding rate of patients and the occurrence of complications,improve the quality of life of patients and improve the clinical adverse symptoms of patients.