一种组织胶改良注射方法联合食管套扎治疗食管胃静脉曲张的临床疗效

摘要

目的 研究内镜下组织胶改良注射方法联合套扎治疗食管胃静脉曲张的临床疗效与安全性.方法 120例食管胃静脉曲张患者随机分为内镜下组织胶改良三明治注射法治疗组(A组)60例(聚桂醇-组织胶-聚桂醇)与内镜下单纯组织胶注射治疗组(B组)60例(碘油-组织胶-碘油).对于合并食管静脉曲张者同步行套扎治疗.比较两组患者内镜下止血成功率、再出血率、胃曲张静脉改善率、食管曲张静脉消失率及并发症发生率.结果 两组患者内镜下止血成功率分别为98.32%与96.41%,差异无统计学意义(P>0.05).A组胃曲张静脉改善率高于B组患者(94.83%vs 82.50%,P<0.05).两组食管曲张静脉消失率分别为86.67%、76.67%,差异具有统计学意义(P<0.05).A组组织胶用量少于B组[(2.47±0.79)mL vs.(3.02±0.68)mL,P<0.05].两组术后再出血、发热、菌血症发生率比较,差异均无统计学意义(P>0.05),但A组患者术后胸腹痛发生率高于B组(70.00%vs 53.33%,P<0.05).B组1例患者术后出现异位肺栓塞,经内科保守治疗好转.结论 内镜下改良组织胶注射方法联合套扎治疗可以发挥组织胶与聚桂醇各自优势而改善食管胃静脉曲张治疗效果,有必要对其做进一步研究.%Objective To investigate the effect and safety of endoscopic injection of tissue adhesive in a modified method combined with ligation for esophageal and gastric varices. Methods 60 patients with esophageal and gastric varices were randomly distributed to the treatment group (group A),who was treated with the modi-fied sandwich method(lauromacrogol -tissue adhesive-lauromacrogol)and combined with ligation for esophageal varices. The treatment group were compared with that 60 controls(group B),who was treated with the traditional sandwich method (lipiodol - tissue adhesive - lipiodol) and combined with ligation for esophageal varices. The hemostatic rate ,rebleeding rate ,improvement rate of gastric varices ,the rates of esophageal varices disappear-ance and complications were compared. Results The hemostasis rate were 98.32% and 96.41% between the two groups (P > 0.05). The improvement rate of gastric va rices (94.83% vs. 82.50%,P < 0.05) and the rate of esophageal varices disappearance(86.67% vs. 76.67%,P < 0.05)in the group A were both higher than those in the group B(49.57% vs. 41.23% ,P < 0.05). The amount of tissue adhesive in the group A was lower than that in the group B(2.47 ± 0.79 mL vs. 3.02 ± 0.68 mL ,P<0.05). The incidence of rebleeding rate ,fever ,transient bacteremia were equal between the two groups(P > 0.05),but the rate of chest and abodminal pain in the group A was higher than those in the group B (70.00% vs. 53.33%,P < 0.05). 1 patient in the group B had ectopic pulmonary embolism ,but improved after treatment. Conclusions Endoscopic injection of tissue adhesive in a modified method combined with ligation is effective and safe for esophageal and gastric varices ,and is worthy fur-ther investigation.