Dai Y P, Gao Q
Department of Gastroenterology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Zhonghua Gan Zang Bing Za Zhi. 2017 Mar 20;25(3):195-199. doi: 10.3760/cma.j.issn.1007-3418.2017.03.007.
To analyze the clinical effect of standardized endoscopic esophageal variceal ligation alone or in combination with tissue adhesive injection for gastric varices (GV) after the first cirrhotic esophageal variceal bleeding. A total of 97 patients who underwent a successful endoscopic therapy in our hospital due to the first cirrhotic esophageal variceal bleeding were enrolled, and according to the subsequent therapeutic regimen, they were divided into control group (48 patients) and treatment group (49 patients). The patients in the control group were given conservative treatment alone, and those in the treatment group were given endoscopic therapy regularly. The therapeutic regimen, changes in varices, complications, and death caused by rebleeding were compared between the two groups. The t-test was used for comparison of continuous data between groups, and the chi-square test or Fisher's exact test was used for comparison of categorical data between groups. The treatment group achieved a remission rate of esophageal varices (EV) of 100% and a GV elimination rate of 93.75% after 2-3 times of endoscopic therapy; the EV recurrence, rebleeding, and mortality rates were 2.04%, 0, and 0, respectively, within 1 month, 16.33%, 4.08%, and 0, respectively, within 12 months, and 20.40%, 14.29%, and 4.08%, respectively, within 20 months; the incidence rate of gastric variceal bleeding (GVB) was 0. In the control group, the EV recurrence, rebleeding, and mortality rates were 4.17%, 2.08%, and 2.08%, respectively, within 1 month, 41.67%, 33.33%, and 8.33%, respectively, within 12 months, and 72.92%, 56.25%, and 20.83%, respectively, within 20 months; the incidence rate of GVB was 18.75%. There were significant differences between the two groups in the incidence rate of GVB ( (2) = 13.605, = 0.001) and EV long-term recurrence, rebleeding, and mortality rates (12 months: (2) = 16.326, < 0.01; 20 months: (2) = 27.144, < 0.01). Gastroscopy and continuous endoscopic therapy for 2-3 times should be performed regularly after the first cirrhotic esophageal variceal bleeding to alleviate EV, eliminate GV, and reduce rebleeding and mortality rates.
分析标准化内镜下食管静脉曲张套扎术单独或联合组织胶注射治疗首次肝硬化食管静脉曲张破裂出血后胃静脉曲张(GV)的临床效果。选取我院97例因首次肝硬化食管静脉曲张破裂出血接受内镜治疗成功的患者,根据后续治疗方案分为对照组(48例)和治疗组(49例)。对照组患者仅给予保守治疗,治疗组患者定期接受内镜治疗。比较两组的治疗方案、静脉曲张变化、并发症及再出血导致的死亡情况。组间连续数据比较采用t检验,分类数据比较采用卡方检验或Fisher确切检验。治疗组经2 - 3次内镜治疗后食管静脉曲张(EV)缓解率达100%,胃静脉曲张消除率达93.75%;1个月内EV复发率、再出血率及死亡率分别为2.04%、0、0,12个月内分别为16.33%、4.08%、0,20个月内分别为20.40%、14.29%、4.08%;胃静脉曲张出血(GVB)发生率为0。对照组1个月内EV复发率、再出血率及死亡率分别为4.17%、2.08%、2.08%,12个月内分别为41.67%、33.33%、8.33%,20个月内分别为72.92%、56.25%、20.83%;GVB发生率为18.75%。两组GVB发生率(χ² = 13.605,P = 0.001)及EV长期复发率、再出血率和死亡率(12个月:χ² = 16.326,P < 0.01;20个月:χ² = 27.144,P < 0.01)比较差异有统计学意义。首次肝硬化食管静脉曲张破裂出血后应定期行胃镜检查并连续进行2 - 3次内镜治疗,以缓解EV,消除GV,降低再出血率和死亡率。