关键词: 肝硬化, 食管胃底静脉曲张破裂出血, 组织胶注射, 曲张静脉套扎术, 治疗

Abstract: Objective The purpose of this study was to investigate clinical efficacy of endoscopic tissue glue injection (ETG) and esophageal variceal ligation (EVL) in the treatment of patients with hepatitis B-induced liver cirrhosis complicated with esophageal variceal bleeding (EGVB). Methods 68 patients with hepatitis B-induced liver cirrhosis and complicated with EGVB were encountered in our hospital between September 2019 and December 2022, and were randomly divided into observation group (n=34) and control group (n=34), received ETG or EVL treatment, respectively, and all were followed-up for one year. The general data, perioperative indexes, blood biochemical indexes before and after treatment and the outcome were compared. Successful hemostasis is based on no active bleeding within 72 hours after operation. Early rebleeding is hematemesis or black stool again within 72 hours to 6 weeks after bleeding control, and delayed rebleeding was confirmed by gastroscopy with active bleeding 6 weeks after operation. Results There were no significant differences as respect to EV (F1, F2 and F3 in the observation group were 32.3%, 50.0% and 17.6%, and in the control were 38.2%, 41.2% and 20.6%, all P>0.05) or Child-Pugh class (class B and C were 76.5% and 23.5%, vs. 76.5% and 23.5%, P>0.05)between the two groups; three patients in the control group died of hemorrhagic shock at emergent stage; of survivals, there were no significant differences respect to liver function tests before and after operation between the two groups(P>0.05); successful hemostasis rate in the observation group was 100.0%, much higher than 83.9% in the control, while re-treatment times, early rebleeding and delayed rebleeding rates were (1.4±0.6)times, 2.9% and 5.9%, all significantly less or lower than [(2.1±0.8)times, 12.9% and 22.6%, respectively, P<0.05] in the control group; post-operationally, incidence of retrosternal pain in the observation was 23.5%, much higher than 6.5% in the control group, while there were no significant differences as respect to incidences of dysphagia, fever, spontaneous bacterial peritonitis and death owing to re-bleeding(8.8%, 8.8%, 5.9% and 8.8% vs. 0.0%, 12.9%, 9.7% and 22.6%, all P>0.05) between the two groups. Conclusion Endoscopic tissue glue injection and EVL in dealing with cirrhotics with urgent EGVB could obtain hemostasis and rescue patients life, and warrants further clinical investigation.

Key words: Liver cirrhosis, Esophagogastric variceal bleeding, Tissue glue injection, Esophageal variceal ligation, Therapy