急诊胃镜下套扎术、硬化术和组织胶注射术治疗食管胃交界区静脉曲张破裂出血效果分析

丁鹏鹏; 张文辉; 祁小宝; 路筝; 王艳玲; 韩晶晶; 陈建宏; 郭春梅; 刘红

doi:10.3969/j.issn.1001-5256.2020.03.019

急诊胃镜下套扎术、硬化术和组织胶注射术治疗食管胃交界区静脉曲张破裂出血效果分析

DOI: 10.3969/j.issn.1001-5256.2020.03.019

1. 首都医科大学附属北京世纪坛医院消化内科
2. 解放军总医院第五医学中心肝硬化诊疗一中心

基金项目:

首都医科大学附属北京世纪坛医院科研课题(2016-q23)；

详细信息

中图分类号: R575.2
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出版历程
- 收稿日期: 2019-09-30
- 出版日期: 2020-03-20

Clinical effect of emergency gastroscopic ligation,sclerotherapy,and tissue adhesive injection in treatment of esophagogastric junctional variceal bleeding

Department of Gastroenterology,Beijing Shijitan Hospital Affiliated to Capital Medical University

Research funding:

摘要

摘要: 目的探讨急诊胃镜下套扎术（EVL）、硬化术（EIS）和组织胶注射术（HI）在食管胃交界区静脉曲张破裂出血治疗中的有效性和安全性,以及不同止血方法的合理选择。方法选取2017年6月-2019年6月北京世纪坛医院和解放军总医院第五医学中心急诊胃镜止血治疗的肝硬化食管胃交界区静脉曲张破裂出血患者共1264例,按照急诊胃镜下不同止血方法进行分组,比较EVL组、EIS组、HI组间的操作成功率、止血成功率、早期再出血率及术后并发症;依据出血位置进行再分类,比较不同出血部位不同止血方法的止血成功率。计量资料3组间比较采用方差分析,计数资料3组间比较采用χ2检验。结果不同止血方法组间操作成功率差异显著（χ2=75. 01,P <0. 05）,EIS、HI操作成功率明显高于EVL,EIS高于HI（P值均<0. 05）。不同止血方法组间止血成功率差异显著（χ2=9. 885,P <0. 05）,HI止血成功率高于EVL及EIS（P值均<0. 05）。不同组间术后早期再出血率差异无统计学意义（χ2...
- 肝硬化 /
- 食管胃接合处 /
- 食管和胃静脉曲张 /
- 出血 /
- 胃镜检查 /
- 止血,内窥镜
Abstract: Objective To investigate the clinical effect of endoscopic variceal ligation( EVL),endoscopic injection sclerotherapy( EIS),and tissue adhesive injection in the treatment of esophagogastric junctional variceal bleeding,and to provide a reference for reasonable selection of different hemostasis methods. Methods A total of 1264 patients with liver cirrhosis and esophagogastric junctional variceal bleeding who underwent emergency gastroscopic hemostasis in Beijing Shijitan Hospital and The Fifth Medical Center of Chinese PLA General Hospital from June 2017 to June 2019 were enrolled and divided into EVL,EIS,HI groups based on the method of emergency gastroscopic hemostasis. These groups were compared in terms of success rate of operation,success rate of hemostasis,early rebleeding rate,and postoperative complications. The patients were also divided into groups based on bleeding site,and the success rates of different hemostasis methods at different sites were compared. An analysis of variance was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. Results The success rate of EIS and tissue adhesive injection was significantly higher than that of EVL,and the success rate of EIS was significantly higher than that of tissue adhesive injection( χ2= 75. 01,P < 0. 05). Tissue adhesive injection had a significantly higher success rate of hemostasis than EVL and EIS( χ2= 9. 885,P < 0. 05). There was no significant difference in early rebleeding rate between groups( χ2= 0. 29,P = 0. 865). The patients undergoing EVL had a significantly higher incidence rate of aspiration and pneumonia than those undergoing EIS or tissue adhesive injection( χ2= 19. 08,P < 0. 05); the patients undergoing tissue adhesive injection had a significantly higher proportion of patients with postoperative pyrexia than those undergoing EVL or EIS( χ2= 23. 94,P < 0. 05); the patients undergoing EVL or tissue adhesive injection had a significantly higher incidence rate of postoperative retrosternal discomfort than those undergoing EIS( χ2= 19. 56,P < 0. 05). EIS and EVL had a high success rate of hemostasis for the bleeding sites at 1-5 cm above the esophagogastric junction( EGJ); EIS and tissue adhesive injection had a similar success rate of hemostasis for the bleeding sites from 1 cm above the EGJ to 2 cm below the EGJ; tissue adhesive injection had a high success rate of hemostasis for the bleeding sites at 2-5 cm below the EGJ. Conclusion EVL,EIS,and tissue adhesive injection are effective methods for the treatment of esophagogastric junctional variceal bleeding,and the selection of hemostasis method based on the location of bleeding site can improve the outcome of hemostasis.
- liver cirrhosis /
- esophagogastric junction /
- esophageal and gastric varices /
- hemorrhage /
- gastroscopy /
- hemostasis,endoscopic

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参考文献(19)

[1] FU LL,SHEN SH,LIU YD,et al. Clinical analysis of the relationship between hemorrhage and position of stigmata in patients with esophageal varices[J]. Chin J Dig Endosc,2018,35(6):396-399.(in Chinese)付来琳，申少华，刘迎娣，等．食管静脉曲张大出血与血栓头位置的临床分析[J]．中华消化内镜杂志，2018,35(6):396-399.

[2] WANG J,ZHENG GZ. Factors related to esophageal variceal bleeding in patients with liver cirrhosis[J/CD]. Chin J Liver Dis(Electronic Version),2019,11(1):42-46.(in Chinese)王娟，郑鸽之．肝硬化食管静脉曲张破裂出血相关因素分析[J/CD]．中国肝脏病杂志(电子版)，2019,11(1):42-46.

[3] HWANG JH,SHERGILL AK,ACOSTA RD,et al. The role of endoscopy in the management of variceal hemorrhage[J].Gastrointest Endosc,2014,80(2):221-227.

[4] KIM DH,CHO E,JUN CH,et al. Risk Factors and on-site rescue treatments for endoscopic variceal ligation failure[J].Korean J Gastroenterol,2018,72(4):188-196.

[5] AJANI JA,BARTHEL JS,BENTREM DJ,et al. Esophageal and esophagogastric junction cancers[J]. J Natl Compr Canc Netw,2011,9(8):830-887.

[6] Chinese Society of Hepatology,Chinese Medical Association;Chinese Society of Gastroenterology,Chinese Medical Association; Chinese Society of Endoscopy,Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol,2016,32(2):203-219.(in Chinese)中华医学会肝病学分会，中华医学会消化病学分会，中华医学会内镜学分会．肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]．临床肝胆病杂志，2016,32(2):203-219.

[7] KUMAMOTO T,KURAHASHI Y,NIWA H,et al. True esophagogastric junction adenocarcinoma:Background of its definition and current surgical trends[J]. Surg Today,2019.[Epub ahead of print]

[8] MANDAL AK,PAUDEL MS,KC S,et al. Factors predicting mortality of acute variceal bleeding in liver cirrhosis[J]. JNMA J Nepal Med Assoc,2018,56(209):493-496.

[9] GARCIA-TSAO G,BOSCH J. Management of varices and variceal hemorrhage in cirrhosis[J]. N Engl J Med,2010,362(9):823-832.

[10] CUI CC,LI DD,LI CF,et al. Risk factors for early rebleeding after first-time endoscopic variceal ligation[J]. J Clin Hepatol,2018,34(7):1445-1451.(in Chinese)崔璨璨，李丹丹，李长锋，等．食管静脉曲张首次套扎术后早期再出血的危险因素分析[J]．临床肝胆病杂志，2018,34(7):1445-1451.

[11] CHO E,JUN CH,CHO SB,et al. Endoscopic variceal ligation-induced ulcer bleeding:What are the risk factors and treatment strategies?[J]. Medicine(Baltimore),2017,96(24):e7157.

[12] ZHANG WH,LI L,HAN J,et al. Endoscopic diagnosis and therapy for 134 cirrhotic patients with cardiac variceal bleeding[J]. Infect Dis Info,2014,27(2):97-99.(in Chinese)张文辉，李莉，韩军，等．肝硬化合并贲门区曲张静脉破裂出血134例内镜诊疗分析[J]．传染病信息，2014,27(2):97-99.

[13] JI JS,CHO YS. Endoscopic band ligation:Beyond prevention and management of gastroesophageal varices[J]. World J Gastroenterol,2013,19(27):4271-4276.

[14] TJWA ET,HOLSTER IL,KUIPERS EJ. Endoscopic management of nonvariceal,nonulcer upper gastrointestinal bleeding[J]. Gastroenterol Clin North Am,2014,43(4):707-719.

[15] LJUBICIC'N,BISC'ANIN A,NIKOLIC'M,et al. A randomizedcontrolled trial of endoscopic treatment of acute esophageal variceal hemorrhage:N-butyl-2-cyanoacrylate injection vs variceal ligation[J]. Hepatogastroenterology, 2011, 58(106):438-443.

[16] KONG DR,XU JM. Selection and application of endoscopic treatments for gastroesophageal varices[J/CD]. Chin J Gastrointestinal Endosc(Electronic Edition),2016,3(4):171-176.(in Chinese)孔德润，许建明．食管胃静脉曲张内镜治疗方法的选择与应用[J/CD]．中华胃肠内镜电子杂志，2016,3(4):171-176.

[17] DU C,CHAI NL,LINGHU EQ,et al. Endoscopic ultrasonography-guided lauromacrogol ablation for pancreatic cystic neoplasms[J]. Chin J Dig Endosc,2017,34(9):653-657.(in Chinese)杜晨，柴宁莉，令狐恩强，等．胰腺囊性肿瘤内镜超声引导下聚桂醇消融术的前瞻性研究[J]．中华消化内镜杂志，2017,34(9):653-657.

[18] SUN YN,LI P,DING HG,et al. Risk factors for early rebleeding after initial sclerotherapy for esophageal varices[J]. J Clin Hepatol,2019,35(1):92-97.(in Chinese)孙亚男，李鹏，丁惠国，等．食管静脉曲张首次硬化剂治疗后早期再出血的危险因素[J]．临床肝胆病杂志，2019,35(1):92-97.

[19] LI C,LI J,HAN T. Effect of endoscopic ligation combined with somatostatin on portal hemodynamics in patients with esophageal variceal bleeding[J]. Clin J Med Offic,2018,46(11):1352-1353,1355.(in Chinese)李超，李京，韩涛．内镜引导下套扎术联合生长抑素对食管静脉曲张破裂出血患者门脉系血流动力学影响[J]．临床军医杂志，2018,46(11):1352-1353,1355.

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