三种内镜下改良组织胶方案治疗孤立性胃静脉曲张的疗效评价

艾正琳; 闵敏; 胡居龙; 梁秀霞; 周玉玲; 马佳丽; 蒋煜; 何玲玲; 李坪

doi:10.12182/20220560102

三种内镜下改良组织胶方案治疗孤立性胃静脉曲张的疗效评价

Efficacy Evaluation of Three Endoscopic Therapies of Isolated Gastric Varices with Modified Tissue Adhesive

摘要

摘要:
目的评估3种内镜下改良组织胶方案治疗孤立性胃静脉曲张的疗效。
方法回顾性分析2008年1月–2019年12月就诊于北京地坛医院的孤立性胃静脉曲张患者73例，收集患者的临床资料，包括年龄、性别、病因、生化指标、Child-Pugh分级、自发性分流的类型、术前出血史、是否合并肝癌等指标。评价内镜下改良组织胶联合聚桂醇治疗、内镜下金属夹辅助组织胶联合聚桂醇治疗、内镜下金属夹和LOOP辅助组织胶联合聚桂醇治疗3种方法的异位栓塞率、生存率、再出血率、聚桂醇和组织胶治疗量、夹子数、治疗次数等临床治疗效果。
结果患者的基线资料中Child-Pugh分级、术前有无血栓形成、是否合并肝癌在3种治疗方式间比较差异有统计学意义（P<0.05）。3种方法的异位栓塞率差异无统计学意义，但内镜下金属夹辅助组织胶联合聚桂醇治疗方案、内镜下金属夹和LOOP辅助组织胶联合聚桂醇治疗方案无异位栓塞发生。3种治疗方法的生存率、再出血率、聚桂醇和组织胶治疗量差异无统计学意义，但夹子数和1年内治疗次数差异有统计学意义（P<0.05）。
结论内镜下金属夹辅助组织胶联合聚桂醇治疗、内镜下金属夹和LOOP辅助组织胶联合聚桂醇治疗，这2种改良内镜下组织胶治疗方案可减少孤立性胃静脉曲张患者1年内治疗次数。

Abstract:
Objective To evaluate the efficacy of three endoscopic therapies of isolated gastric varices (IGV) with modified tissue adhesive.
Methods A retrospective analysis was conducted with the clinical data of 73 IGV patients who were treated between January 2008 and December 2019 at Beijing Ditan Hospital. Patient clinical data on age, sex, etiology, biochemistry findings, Child-Pugh classification, the type of spontaneous shunt, preoperative bleeding history, and the presence or absence of liver cancer were collected. The three therapies evaluated were endoscopic intravenous injection of tissue glue combined with lauromacrogol, endoscopic clip-assisted intravenous injection of tissue glue combined with lauromacrogol, and endoscopic clip and LOOP-assisted intravenous injection of tissue glue combined with lauromacrogol. Their respective clinical treatment outcomes, including ectopic embolism rate, survival rate, rebleeding rate, amount of lauromacrogol and tissue glue used, the number of endoscopic clips used, and the number of times of the procedure the patient underwent, were evaluated.
Results In the patient baseline data, Child-Pugh grade, preoperative thrombus formation, and the presence or absence of liver cancer, showed significant difference between the three therapies (P<0.05). There was no significant difference in the rates of ectopic embolism among the three methods (P>0.05), but no ectopic embolism occurred after endoscopic clip-assisted intravenous injection of tissue glue combined with lauromacrogol, or after endoscopic clip and LOOP-assisted intravenous injection of tissue glue combined with lauromacrogol. There was no significant difference in the survival rate, the rebleeding rate, amount of lauromacrogol and tissue glue used for the three therapies, but there was significant difference in the number of endoscopic clips used and the number of times the procedure was conducted within one year (P<0.05).
Conclusion The two endoscopic therapies of intravenous injection of modified tissue glue, one assisted by clip and the other assisted by clip and LOOP, can help reduce the number of procedures IGV patients undergo within one year.

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