生长抑素联合内镜下治疗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.1672-5069.2025.01.027

摘要/Abstract

摘要： 目的研究生长抑素联合内镜下治疗肝硬化并发食管胃底静脉曲张破裂出血(EVB)患者的效果。方法 2017年1月～2023年11月我院收治的肝硬化并发EVB患者89例,被随机分为对照组45例和观察组44例,分别给予以生长抑素为主的内科综合治疗,或在此治疗的基础上,行内镜下组织胶注射和曲张静脉套扎术治疗,随访6个月。使用超声诊断仪检测门静脉直径(PVD)、门静脉血流流速(PVV)和脾静脉血流流速(SVV),采用ELISA法检测血清过氧化脂质(LPO)、胃动素(MTL)和胃泌素(GAS)。结果观察组止血成功率为97.7%,显著高于对照组的88.9%(P<0.05);观察组输血(1.8±0.4)u,显著少于对照组【(4.2±2.0)u,P<0.05】,止血时间为(0.8±0.2) d,显著短于对照组【(3.1±1.1)d,P<0.05】,胃镜复查观察组EV消失9例(20.9%); 治疗前后,两组PVD、PVV和SVV差异无统计学意义(P>0.05);治疗后,观察组血清LPO、MTL和GAS分别为(4.3±1.1)U/L、(193.6±20.4)ng/L和(85.5±9.2)μg/mL,均显著低于对照组【分别为(7.1±1.6)U/L、(254.9±24.9)ng/L和(112.4±10.3)μg/mL,P<0.05】;随访6个月,观察组再出血3例(7.0%),经再次内镜下治疗等综合处理,止血,对照组再出血17例(42.5%,P<0.05),经内科综合治疗止血12例,死亡5例(29.4%)。结论在内科综合治疗的基础上采取内镜下组织胶注射或/和曲张静脉套扎术是抢救肝硬化并发EVB患者比较有效的方法,但设备和技术要求高,治疗有一定的难度,需要综合培训方能达到治疗目的

关键词: 肝硬化, 胃底静脉曲张破裂出血, 生长抑素, 内镜下组织胶注射, 曲张静脉套扎术, 治疗

Abstract: Objective The aim of this study was to investigate clinical efficacy of endoscopic tissue gel injection (ETGI) and endoscopic variceal ligation (EVL) in treatment of cirrhotics with esophagogastric variceal bleeding (EVB). Methods 89 patients with liver cirrhosis (LC) and complicated EVB were encountered in our hospital between January 2017 and November 2023, and were divided into control (n=45) and observation group (n=44). All patients were well treated by internal comprehensive supporting measurement, including hemostasis, blood transfusion and intravenous somatostatin administration, and patients in the observation group received ETGI and/or EVL at base of supporting treatment. Portal vein diameter (PVD), portal vein velocity (PVV) and splenic vein velocity (SVV) were detected by ultrasonography, and serum lipid peroxide (LPO), motilin (MTL) and gastrin (GAS) levels were assayed by ELISA. Results Successful hemostasis rate in the observation group was 97.7%, much higher than 88.9%(P<0.05) in the control; blood transfusion was (1.8±0.4)u, much less than [(4.2±2.0)u, P<0.05], hemostasis time was (0.8±0.2) day, much shorter than [(3.1±1.1)day, P<0.05] in the control, and disappearance of EV at re-gastroscopy in 9 cases (20.9%) in the observation group; there were no significant differences as respect to PVD, PVV and SVV in the two groups (P>0.05); after treatment, serum LPO, MTL and GAS levels in the observation group were (4.3±1.1)U/L, (193.6±20.4)ng/L and (85.5±9.2)μg/mL, all much lower than [(7.1±1.6)U/L, (254.9±24.9)ng/L and (112.4±10.3)μg/mL, respectively, P<0.05] in the control; by end of six-month follow-up, re-bleeding was found in 3 cases (7.0%) in the observation group, and they recovered after ETGI and/or EVL, while re-bleeding occurred in 17 cases (42.5%, P<0.05) in the control, and 5 (29.4%)of them died. Conclusion ETGI and/or EVL at supporting measures in dealing with emergent patients with EVB is efficacious in saving patient’s lives, which might be carried out by qualified clinicians.

Key words: Liver cirrhosis, Esophagogastric variceal bleeding, Endoscopic tissue gel injection, Endoscopic variceal ligation, Somatostatin, Therapy

朱瑞农, 宋丽群, 钱佶. 生长抑素联合内镜下治疗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, 2025, 28(1): 104-107.

Zhu Ruinong, Song Liqun, Qian Ji. Endoscopic tissue gel injection and endoscopic variceal ligation in treatment of cirrhotics with esophagogastric variceal bleeding[J]. Journal of Practical Hepatology, 2025, 28(1): 104-107.

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生长抑素联合内镜下治疗肝硬化并发食管胃底静脉曲张破裂出血患者疗效研究^*

Endoscopic tissue gel injection and endoscopic variceal ligation in treatment of cirrhotics with esophagogastric variceal bleeding

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