生长抑素与生长抑素联合内镜下治疗肝硬化并食管胃底静脉曲张出血患者的疗效观察

摘要

目的：观察生长抑素与生长抑素联合内镜下聚桂醇+组织黏合剂治疗肝硬化并食管胃底静脉曲张出血（esophageal gastric varices bleeding，EGVB）患者的临床疗效。方法分析首都医科大学附属北京地坛医院2014年1月至2014年12月收治的167例肝硬化并EGVB患者，对照组（21例）仅给予生长抑素治疗，治疗组（146例）给予生长抑素联合内镜下治疗，两组均应用保肝、利尿及普萘洛尔治疗，观察急诊止血成功率以及随访1周、1个月、3个月后两组患者曲张静脉的消失率和病死率。结果对照组和治疗组的急诊止血成功率分别为90.5%（19/21）和99.3%（145/146），差异有统计学意义（χ2=4.065，P =0.042）。随访1周、1个月、3个月，两组再出血率分别为9.5%（2/21）、23.8%（5/21）、42.9%（9/21）和0.7%（1/146）、2.1%（3/146）和3.4%（5/146），差异有统计学意义（χ2值分别为4.065、14.579和32.212，P值分别为0.042、0.000和0.000）。随访至3个月，两组曲张静脉消失率为分别为0%（0/21）和21.2%（31/146），差异有统计学意义（χ2=4.161，P =0.041）；两组病死率分别为为9.5%（2/21）、0%（1/146），差异有统计学意义（χ2=5.894，P =0.015）。结论生长抑素联合内镜治疗肝硬化并EGVB患者，曲张静脉消失率显著增加，病死率显著下降，是一种止血快、效果好且安全有效的方法。%Objective To observe the clinical effect of somatostatin and somatostatin combined with endoscope in treatment of liver cirrhosis patients with esophageal gastric varices bleeding (EGVB).Methods Total of 167 liver cirrhosis patients with EGVB from January 2014 to December 2014 in Beijing Ditan Hospital, Capital Medical University were selected. The control group (21 cases) were treated with somatostatin and the treatment group (146 cases) were treated with somatostatin combined with endoscopic lauromacrogol + tissue adhesive. Both groups were also given liver protection drugs, diuresis and propranolol. The rates of emergency hemostasis, varicose vein disappearance and mortality after following-up 1 week, 1 month and 3 months were observed. Results The rates of emergency hemostasis in control group and treatment group were 90.5% (19/21) and 99.3%(145/146), respectively, and the difference was statistically signiifcant (χ2 = 4.065,P = 0.042). After following-up for 1 week, 1 month and 3 months, the rebleeding rate was 9.5% (2/21), 23.8% (5/21) and 42.9% (9/21) in control group and 0.7% (1/146), 2.1% (3/146) and 3.4% (5/146) in treatment group, respectively, the differences were statistically significant (χ2 = 4.065, 14.579, 32.212;P = 0.042, 0.000, 0.000). After following-up for 3 months, the rate of varicose veins disappeared was 0% (0/21) in control group and 21.2% (31/146) in treatment group, the difference was statistically signiifcant (χ2 = 4.161, P = 0.041). The mortality rate was 9.5% (2/21) in control group and 0% (1/146) in treatment group, the difference was statistically signiifcant (χ2 = 5.894,P = 0.015). Conclusions Somatostatin combined with endoscope in treatment of liver cirrhosis patients with EGVB is a fast, safe and effective method, which can reduce the varicosed vein disappearance rate and the mortality rate signiifcantly.