内镜下套扎术与组织胶注射术治疗1型胃食管静脉曲张破裂出血的疗效观察

Clinical efficacy of endoscopic gastric variceal ligation vs. gastric variceal obliteration in treating type 1 gastroesophageal varices bleeding

摘要:

目的：比较并评估内镜下应用胃静脉曲张套扎术（gastric variceal ligation，GVL）与组织胶注射术（gastric variceal oblit－eration，GVO）治疗胃食管静脉曲张1型（type 1 gastroesophageal varices，GOV1）破裂出血的疗效和安全性。方法：回顾性分析GOV1胃静脉曲张（gastric variceal，GV）破裂出血患者临床资料，其中GVL治疗61例，GVO治疗69例，比较并评估2组患者的急性止血成功率、静脉曲张消除和缓解率、再出血率和并发症发生率等。结果：GVL与GVO均可以迅速有效控制急性胃静脉曲张破裂出血，其中GVL组止血成功率为 100.00%，GVO组为98.04%，2组间无统计学差异（P=1.000）。2种方法均可以有效控制再出血率，其中GVL组再出血率为16.39%，GVO组为23.19%，2组间无统计学差异（P=0.334）。2种方法均可以有效消除静脉曲张，其中GVL组静脉曲张消除率为52.46%，GVO组为50.72%，2组间无统计学差异（P=0.756）。GVL组术后并发症总发生率为16.39%，GVO组术后并发症总发生率为40.58%，2组间有统计学差异，GVO术后并发症总发生率更高（P=0.004）。结论：GVL与GVO在急性止血效果、静脉曲张消除效果及再出血风险方面无统计学差异，但GVL并发症发生率更低。

Abstract:

Objective：To evaluate the clinical efficacy and safety of gastric variceal ligation（GVL） vs. gastric variceal obliteration（GVO） in controlling type 1 gastroesophageal varices（GOV1） bleeding. Methods：The clinical data of patients with GOV1 gastric variceal bleeding were analyzed retrospectively，including 61 cases treated with GVL（GVL group） and 69 cases treated with GVO（GVO group）. The hemostatic success rate，gastric variceal（GV）eradication rate，rebleeding rate and complications incidence were compared between GVO and GVL treatment groups. Results：Both GVO and GVL treatment groups were effective in controlling acute GV hemor－rhage and had the similar hemostasis rate，98.04% in GVO group and 100.00% in GVL group，without significant differences（P=1.000）. During the follow-up period，23.19% of GVO patients experienced rebleeding，compared with 16.39% rebleeding rate in GVL-treated patients，but the rebleeding rates were not significantly different between the two groups（P=0.334）. 50.72% of patients treated with GVO and 52.46% of patients treated with GVL were found gastric varices reduction or eradication，with no significant difference between two groups（P=0.756）. The incidence of complications in GVL group were 16.39%，whereas 40.58% of patients were found with complications in GVO group，with significant differences between the two groups（P=0.004）. Conclusion：Our results show that GVL and GVO are both effective in controlling gastric variceal bleeding and rebleeding，but the complications incidence of GVL is lower than that of GVO.