内镜下套扎和注射硬化剂治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者疗效研究*

doi:10.3969/j.issn.1672-5069.2023.01.023

实用肝脏病杂志 ›› 2023, Vol. 26 ›› Issue (1): 87-90.doi: 10.3969/j.issn.1672-5069.2023.01.023

内镜下套扎和注射硬化剂治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者疗效研究^*

戴欢, 李凯, 朱永湘, 王超

215600 江苏省张家港市第一人民医院消化内科(戴欢,李凯,朱永湘);苏州大学附属第一医院消化内科(王超)

收稿日期:2022-03-17 出版日期:2023-01-10 发布日期:2023-02-07
通讯作者: 李凯,E-mail:790518531@qq.com
作者简介:戴欢,女,38岁,大学本科,副主任医师。E-mail:doctordaihuan@163.com
基金资助:
^*国家临床重点专科建设项目(编号:2011873)

Efficacy of endoscopic ligation and tissue glue injection in the treatment of patients with hepatitis B liver cirrhosis and esophageal and gastric varices bleeding

Dai Huan, Li Kai, Zhu Yongxiang, et al

Department of Gastroenterology, First People's Hospital, Zhangjiagang 215600,Jiangsu Province, China

Received:2022-03-17 Online:2023-01-10 Published:2023-02-07

摘要/Abstract

摘要： 目的探讨采取内镜下套扎和注射硬化剂治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血(EVB)患者的疗效。方法 2016年2月～2021年1月在我院接受治疗的乙型肝炎肝硬化并发EVB患者80例,均接受常规抑酸、止血和输血等处理,其中40例对照组接受普萘洛尔治疗,另40例观察组患者接受内镜下套扎和注射硬化剂治疗,术后口服普萘洛尔。随访所有患者6个月。使用超声检测门静脉内径(DPV)、门静脉血流速度(VPV)和门静脉血流量(QPV),采用ELISA法检测血清胃泌素(GAS)、胃动素(MTL)、过氧化脂质(LPO)和丙二醛(MDA)水平。结果观察组输血量、止血时间和住院日分别为(3.2±0.6) u、(23.8±5.1)h和(7.5±1.3)d,均显著少于或短于对照组[分别为(5.0±0.9) u、(47.9±7.5)h和(12.1±1.5)d,P<0.05];治疗后,观察组VPV和QPV分别为(18.7±2.3)cm/s和(510.2±52.2)ml/min,显著低于对照组[分别为(22.2±2.4)cm/s和(645.2±64.1)ml/min,P<0.05];观察组血清GAS、MTL、LPO和MDA水平分别为(98.2±9.1)μg/ml、(219.5±20.2)ng/l、(5.1±1.5)U/l和(13.6±3.4)μmol/l,均显著低于对照组[分别为(112.4±11.7)μg/ml、(251.2±20.4)ng/l、(15.2±6.8)U/l和(22.1±5.3)μmol/l,P<0.05];随访6个月,观察组再出血率和病死率分别为15.0%和5.0%,显著低于对照组的40.0%和30.0%(P<0.05)。结论采取内镜下套扎和注射硬化剂治疗乙型肝炎肝硬化并发EVB患者效果显著,能降低再出血发生率,提高生存率,可能与有效改善了血流动力学和胃肠动力学有关。

关键词: 食管胃底静脉曲张破裂出血, 肝硬化, 内镜下套扎, 硬化剂注射, 治疗

Abstract: Objective The aim of this study was to investigate the efficacy of endoscopic varices ligation (EVL) and tissue glue injection (TGI) in the treatment of patients with hepatitis B liver cirrhosis (LC) and esophageal and gastric varices bleeding (EVB). Methods 80 patients with LC and EVB were encountered in our hospital between February 2016 and January 2021, and all were carefully managed by conventional hemostasis measures. 40 patients in the control taken propranolol orally after hemostasis, and another 40 patients in the observation group received EVL and TGI. All patients were followed-up for six months. The portal venous diameter (DPV), portal venous blood velocity (VPV) and blood quantities of portal vein (QPV) were detected by ultrasonography. Serum gastrin (GAS), motilin (MTL), lipid peroxide (LPO) and malondialdehyde (MDA) levels were assayed by ELISA. Results The amount of blood transfusion, hemostatic time and hospital stay in the observation group were (3.2±0.6) u,(23.8±5.1)h and (7.5±1.3)d, significantly less or shorter than [(5.0±0.9) u, (47.9±7.5)h and (12.1±1.5)d, respectively, P<0.05] in the control; after treatment, the VPV and QPV in the observation were (18.7±2.3)cm/s and (510.2±52.2) ml/min, both significantly lower than [(22.2±2.4)cm/s and (645.2±64.1)ml/min, respectively, P<0.05] in the control; serum GAS, MTL, LPO and MDA levels in the observation were (98.2±9.1)μg/ml, (219.5±20.2)ng/l, (5.1±1.5)U/l and (13.6±3.4)μmol/l, all significantly lower [(112.4±11.7)μg/ml,(251.2±20.4)ng/l,(15.2±6.8)U/l and (22.1±5.3)μmol/l, respectively, P<0.05]; at the end of six-month follow-up, the incidences of re-bleeding and fatality in the observation were 15.0% and 5.0%, both significantly lower than 40.0% and 30.0%(P<0.05) in the control group. Conclusion The EVL and TGI in the treatment of hepatitis B cirrhotics with complicated EVB is efficacious with a promising hemostatic effect and elevated survival, which warrants further clinical investigation.

Key words: Esophageal and gastric varices bleeding, Liver cirrhosis, Endoscopic varices ligation, Tissue glue injection, Therapy

戴欢, 李凯, 朱永湘, 王超. 内镜下套扎和注射硬化剂治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者疗效研究^*[J]. 实用肝脏病杂志, 2023, 26(1): 87-90.

Dai Huan, Li Kai, Zhu Yongxiang, et al. Efficacy of endoscopic ligation and tissue glue injection in the treatment of patients with hepatitis B liver cirrhosis and esophageal and gastric varices bleeding[J]. Journal of Practical Hepatology, 2023, 26(1): 87-90.

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内镜下套扎和注射硬化剂治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者疗效研究^*

Efficacy of endoscopic ligation and tissue glue injection in the treatment of patients with hepatitis B liver cirrhosis and esophageal and gastric varices bleeding

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