摘要
背景肝硬化食管胃底静脉曲张(esophagogastric varices,EGV)破裂出血经内镜下胃底组织胶注射(endoscopic gastric glue injection,EGGI)联合食管静脉曲张套扎术(endoscopicvariceal ligation,EVL)成功止血后再出血率仍较高,常需给予二次EVL治疗,但首次与二次EVL最佳间隔时间尚未确定.目的探讨EGGI联合EVL术后再次EVL时机对预防肝硬化食管胃静脉曲张患者再出血影响.方法回顾性选取2017-05/2019-09我院收治的121例初次EGGI联合EVL成功止血的肝硬化出血患者,根据再次EVL治疗时机不同分为1个月组(n=27)、2个月组(n=32)、3个月组(n=37)、3个月以上组(n=25),比较各组第二次EVL完成后疗效、再出血率、病死率、并发症发生率、门脉血流动力学变化(脾静脉、门静脉、胃左静脉内径与平均血流速度).结果1个月组总有效率为100.00%(27/27),高于2个月组的78.13%(25/32)、3个月组75.68%(28/37)、3个月以上组68.00%(17/25)(P<0.05);1个月组再出血率为3.70%(1/27),低于2个月组31.25%(10/32)、3个月组37.84%(14/37)、3个月以上组的68.00%(17/25),2个月组再出血率低于3个月以上组(P<0.05);1个月组病死率为0,低于3个月以上组的24.00%(6/25)(P<0.05);1个月组第二次EVL后脾静脉、门静脉平均血流速度分别为(32.42±3.36)cm/s、(27.51±2.79)cm/s,高于2个月组的(30.02±2.77)cm/s、(24.55±2.61)cm/s,3个月组的(29.11±3.24)cm/s、(24.19±2.38)cm/s,3个月以上组的(29.04±2.81)cm/s、(23.89±2.11)cm/s(P<0.05).结论内镜下胃底组织胶注射联合套扎术后早期再次套扎术能改善静脉曲张严重程度,降低再出血率,疗效显著,安全可靠,并能对门静脉系统产生积极影响.
BACKGROUND The rate of rebleeding after successful hemostasis by endoscopic gastric glue injection(EGGI)combined with endoscopic variceal ligation(EVL)in ruptured esophago-gastric varices(EHV)in cirrhosis is still high,and a second EVL is often required,but the optimal interval between the first and second EVL has not been determined.AIM To explore the effect of timing of the second EVL after EGGI combined with EVL in the prevention of rebleeding from esophagogastric varices in patients with liver cirrhosis.METHODS A total of 121 patients with cirrhosis and hemorrhage who were treated at our hospital from May 2017 to September 2019 were retrospectively selected and divided into 1 mo group(n=27),2 mo group(n=32),3 mo group(n=37),and>3 mo group(n=25)based on the interval between the first and second EVL.The curative effect,rebleeding rate,fatality rate,rate of complications and portal hemodynamic changes(splenic vein,portal vein,and left gastric vein diameter and mean blood flow velocity)after the completion of the second EVL were compared among the groups.RESULTS The total effective rate in the 1 mo group was 100.00%(27/27),significantly higher than those of the 2 mo[78.13%(25/32)],3 mo[75.68%(28/37)],and>3 mo[68.00%(17/25)]groups(P<0.05).The rebleeding rate in the 1 mo group[3.70%(1/27)]was significantly lower than those of the 2 mo[31.25%(10/32)],3 mo[37.84%(14/32)],and>3 mo[68.00%(17/25)]groups(P<0.05);the rebleeding rate in the 2 mo group was significantly lower than that of the>3 mo group(P<0.05).The mortality rate in the 1 mo group(0)was significantly lower than that of the>3 mo group[24.00%(6/25)](P<0.05).The average blood flow velocity of the splenic vein and portal vein after the second EVL in the 1 mo group[(32.42±3.36)cm/s and(27.51±2.79)cm/s,respectively]were significantly higher than those of the 2 mo[(30.02±2.77)cm/s and(24.55±2.61)cm/s,respectively],3 mo[(29.11±3.24)cm/s and(24.19±2.38)cm/s,respectively],and>3 mo[(29.04±2.81)cm/s and(23.89±2.11)cm/s,respectively]groups(P<0.05).CONCLUSION Early re-ligation after EGGI combined with EVL can effectively,safely,and reliably improve the severity of varicose veins and reduce the rebleeding rate,and has a positive impact on the portal venous system.
作者
刘慧民
龚志斌
Hui-Min Liu;Zhi-Bin Gong(Department of Internal Medicine,Lianshi People’s Hospital,Nanxun District,Huzhou 313013,Zhejiang Province,China;Department of Gastroenterology,Jiangxi Provincial People’s Hospital,Nanchang 330006,Jiangxi Province,China)
出处
《世界华人消化杂志》
CAS
2022年第17期748-755,共8页
World Chinese Journal of Digestology
