大容量套扎器套扎与组织胶联合聚桂醇注射治疗GOV型胃底静脉曲张的比较研究

doi:10.11958/20231728

天津医药 ›› 2024, Vol. 52 ›› Issue (6): 604-609.doi: 10.11958/20231728

大容量套扎器套扎与组织胶联合聚桂醇注射治疗GOV型胃底静脉曲张的比较研究

石玉茹¹(), 石定²^,^△()

1 河南中医药大学第一附属医院消化科（邮编450000）
2 宁波市第二医院消化科

收稿日期:2023-11-08 修回日期:2023-12-04 出版日期:2024-06-15 发布日期:2024-06-06
通讯作者: ^△E-mail：shidingyuhang@163.com
作者简介:石玉茹（1997），女，硕士研究生，主要从事消化系统疾病内镜下治疗的相关研究。E-mail：shiyuru970719@163.com
基金资助:
浙江省医药卫生科研基金(2022KY326)

A comparative study of the treatment of GOV type gastric varices with large-volume band ligators and tissue glue combined with lauromacrogol injection

SHI Yuru¹(), SHI Ding²^,^△()

1 Department of Gastroenterology, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China
2 Department of Gastroenterology, Ningbo NO.2 Hospital

Received:2023-11-08 Revised:2023-12-04 Published:2024-06-15 Online:2024-06-06
Contact: ^△E-mail: shidingyuhang@163.com

石玉茹, 石定. 大容量套扎器套扎与组织胶联合聚桂醇注射治疗GOV型胃底静脉曲张的比较研究[J]. 天津医药, 2024, 52(6): 604-609.

SHI Yuru, SHI Ding. A comparative study of the treatment of GOV type gastric varices with large-volume band ligators and tissue glue combined with lauromacrogol injection[J]. Tianjin Medical Journal, 2024, 52(6): 604-609.

摘要/Abstract

摘要：

目的比较大容量套扎器与组织胶注射治疗食管胃静脉曲张（GOV）型胃静脉曲张的疗效和安全性，为GOV型胃静脉曲张的治疗提供参考。方法前瞻性纳入150例GOV型胃静脉曲张患者。结合患者病情及意愿将患者分为内镜下曲张静脉套扎术（EBL组，78例）和内镜下曲张静脉栓塞术（EVO组，72例）。EBL组采用大容量套扎器对GOV型胃静脉曲张进行内镜下套扎治疗；EVO组使用组织胶联合聚桂醇注射治疗。所有患者于首次术后2~3周复查胃镜，观察有无曲张静脉残留及出血（若有，此次随访时需再次治疗）。分别于术后1、3、6个月进行胃镜检查，评估内镜治疗后主要观察指标：曲张静脉止血成功率、技术成功率、根除率、复发率；次要指标（相关并发症）：内镜治疗相关出血、发热、败血症和远处栓塞。结果 EBL组和EVO组技术成功率、止血成功率、平均治疗次数、胃底静脉曲张根除率差异无统计学意义。EVO组复发率高于EBL组（P<0.05）。EBL组内镜治疗相关出血率低于EVO组，发热率低于EVO组（P<0.05）；EVO组中1例患者在注射后发生肺栓塞，3例患者出现败血症。结论大容量套扎器与内镜下注射组织胶根除GOV型胃静脉曲张的短期疗效相似，但前者安全性优于后者。

关键词: 食管和胃静脉曲张, 出血, 套扎疗法, 内窥镜检查, 组织胶

Abstract:

Objective To compare the efficacy and safety of large volume ligation device and tissue glue injection in the treatment of GOV gastric varicose veins, and to provide reference for the treatment of GOV gastric varicose veins. Methods A total of 150 patients with GOV type gastric varicose veins were prospectively included. Patients were divided into the endoscopic varicose vein ligation (EBL) group (78 cases) and the endoscopic varicose vein embolization (EVO) group (72 cases) according to their condition and willingness. In EBL group, GOV type gastric varices were treated by endoscopic ligation with a large volume ligation device. The EVO group was treated with tissue glue combined with cinnamyl alcohol injection. All patients were re-examined with gastroscopy 2-3 weeks after the first operation to observe whether varicose veins were residual and bleeding (if so, treatment should be repeated at this follow-up visit). Gastroscopy was performed at 1, 3 and 6 months after surgery to evaluate the main outcome measures after endoscopic treatment, including success rate of varicose vein hemostasis, technical success rate, eradication rate, recurrence rate and related complications (secondary indicators): endoscopy-related bleeding, fever, sepsis and distant embolization. Results There were no significant differences in technical success rate, hemostasis success rate, average treatment times and 6-month eradication rate of gastric varices between the EBL group and the EVO group. The recurrence rate was higher in the EVO group than that of EBL group (P<0.05). The endoscopy-related bleeding rate and fever rate were lower in the EBL group than those in the EVO group (P<0.05). In the EVO group, 1 patient developed pulmonary embolism after injection and 3 patients developed septicemia. Conclusion The short-term efficacy of high volume ligation device is similar to that of endoscopic injection of tissue glue in eradicating GOV gastric varices, but the former is safer than the latter.

Key words: esophageal and gastric varices, hemorrhage, cuff ligating therapy, endoscopy, tissue adhesives

中图分类号:

R573.9

图/表 7

图1 CTA显示胃肾分流

Fig.1 CTA showing gastrorenal shunt

图2 套扎治疗胃底静脉曲张出血 A：内镜显示胃底静脉曲张喷射状出血；B：出血部位被套扎；C：套扎后内镜显示出血停止。

Fig.2 Treatment of gastric variceal bleeding by ligation

图3 套扎治疗GOV1型胃底静脉曲张 A：套扎前内镜显示胃底静脉曲张；B：套扎器捕捉靶静脉；C：套扎后内镜下图像；D：套扎后4周内镜显示胃静脉曲张消失。

Fig.3 Ligation for GOV1 type gastric varices

图4 套扎治疗GOV2型胃底静脉曲张 A：套扎前内镜显示胃底静脉曲张；B：套扎器捕捉靶静脉；C：套扎后内镜下图像；D：套扎后4周内镜显示胃静脉曲张消失。

Fig.4 Ligation for GOV2 type gastric varices

图5 组织胶注射治疗胃底静脉曲张出血 A：内镜显示胃底静脉曲张喷射状出血；B：于出血部位注射组织胶；C：注射组织胶后出血停止。

Fig.5 Tissue glue injection for gastric variceal bleeding

表1 2组一般资料比较

Tab.1 Comparison of general data between the two groups

组别		n		男/女		年龄/岁			病因（A/B/C/D）^▲				腹水
EBL组		78		52/26		57.40±10.34			55/10/10/3				48（61.5）
EVO组		72		55/17		57.29±10.32			54/12/4/2				37（51.4）
χ²或t				1.731		0.063			2.727				1.571
组别	门脉高压性胃病				门静脉直径/mm			Child-Pugh 分级（A/B/C）			GOV类型（GOV1/GOV2）
EBL组	38（48.7）				14.32±2.27			16/44/18			45/33
EVO组	30（41.7）				14.65±2.92			13/47/12			51/21
χ²或t	0.751				0.781			1.371			2.806
组别			GV分级（F1/F2/F3）				治疗前出血			胃肾分流		胃底静脉曲张直径/mm
EBL组			9/40/29				26（33.3）			32（41.0）		15.09±2.65
EVO组			4/41/27				15（20.8）			28（38.9）		15.25±2.22
χ²或t			1.770				2.945			0.071		0.399

表2 2组术后并发症比较 [例（%）]

Tab.2 Comparison of postoperative complications between the two groups

组别	n	内镜治疗相关出血	发热	败血症	远处栓塞
EBL组	78	2（2.56）	13（16.67）	0	0
EVO组	72	8（11.11）	22（30.56）	3（4.16）	1（1.39）
χ²或P		0.049^▲	4.037^＊	0.108^▲	0.480^▲

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大容量套扎器套扎与组织胶联合聚桂醇注射治疗GOV型胃底静脉曲张的比较研究

A comparative study of the treatment of GOV type gastric varices with large-volume band ligators and tissue glue combined with lauromacrogol injection

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