食管胃底静脉曲张破裂出血的内镜下治疗效果

胡娜 叶长根 戴华梅 杨力 向阳 查诚宜 冷芳

[關键词] 食管胃底静脉曲张破裂出血;内镜;硬化剂;组织胶

[中图分类号] R571.3          [文献标识码] B          [文章编号] 1673-9701（2021）29-0060-04

Effect of endoscopic treatment for esophagogastric variceal bleeding

HU Na   YE Changgen   DAI Huamei   YANG Li   XIANG Yang   ZHA Chengyi   LENG Fang

Department of Gastroenterology， Jingdezhen Third People's Hospital in Jiangxi Province， Jingdezhen   333000， China

[Abstract] Objective To explore the effect of endoscopic treatment for esophagogastric variceal bleeding. Methods A total of sixty patients with esophagogastric variceal bleeding who were admitted to our hospital from June 2017 to February 2020 were selected by the convenience sampling method， and were randomly divided into the control group and the observation group. Twenty patients in the control group were treated with internal medicine therapy （PPI+octreotide）. Forty patients in the observation group were treated with accurate endoscopic treatment， including endoscopic loop ligature， and the injection of sclerosing agent and tissue adhesive. The success rate of hemostasis， varicose vein improvement rates， and varicose vein diameters， VAS scores， incidences of adverse reactions， the hemostasis time， hospitalization durations， hospitalization costs and follow-up result were compared between the two groups. Results The success rate of hemostasis and the varicose vein improvement rate in the observation group were higher than those in the control group， and the differences between the two groups were statistically significant（P<0.05）. Before treatment， no statistical differences were observed in the varicose vein diameter and VAS score between the two groups（P>0.05）. After treatment， varicose vein diameters and VAS scores were decreased in both groups， and the varicose vein diameter and VAS score in the observation group were significantly lower than those in the control group， the difference was statistically significant（P<0.05）. No statistical difference was observed in the total incidence of adverse reactions between the two groups （P>0.05）. The average hemostasis time in the observation group was shorter than that in the control group， and the difference was statistically significant （P<0.05）. No statistical differences were observed in hospitalization durations and hospitalization costs between the two groups （P>0.05）. After the end of the experiment， patients in the two groups were followed up for 6 months. The rate of early rebleeding in the observation group was significantly lower than that in the control group， while no statistical differences were observed in the rates of long-term rebleeding， loss of varicose veins and death between the two groups （P>0.05）. Conclusion The implementation of accurate endoscopic therapy will provide more effective treatment measures for patients with esophagogastric variceal bleeding， reduce the mortality rate of such patients， prolong the life cycle and improve the quality of life.

[Key words] Esophagogastric variceal bleeding; Endoscope; Sclerosing agent; Tissue adhesive

食管胃底静脉曲张破裂出血（Esophageal and gastric varices bleeding，EGVB）是肝硬化失代偿期患者常见且严重的并发症之一，具有出血量大、起病骤然、病情发病快、病死率高等特点[1]。若未得到及时有效的止血，将会影响患者的循环系统，在短时间内危及患者生命[2]。因此，如何在最短时间内采取准确有效的治疗是改善肝硬化EGVB患者预后恢复的关键[3]。现如今，临床治疗食管胃底静脉曲张治疗方式较为繁多，主要包含外科手术、药物、介入及内镜辅助下治疗等。单一使用药物治疗，治疗过程相对较长，极易出现再出血等状况;介入治疗有引发肝性脑病的风险，远期疗效差[3]。另外，外科手术治疗，对患者肝脏功能及机体状态较差的患者难以开展，同时外科手术对患者造成的创伤较大、恢复慢、并发症风险高。随着我国医疗水平及医疗设备的迅速发展，内镜技术已然成为治疗食管胃底静脉曲张重要的手段之一，具有创伤小、止血迅速等优势[4-5]。本研究就近年来EGVB患者采取不同内镜治疗的临床效果进行分析，以期为该病的治疗提供科学依据，现报道如下。

1 资料与方法

1.1 一般资料

本研究病例资料均来源于2017年6月至2020年2月我院临床诊断为肝硬化的患者60例，将符合纳入标准的患者以随机数字表法分为两组，对照组20例，男女比例为13：7;年龄33～81岁，平均（57.01±6.32）岁;其中食管静脉……