球囊压迫辅助下内镜硬化剂注射治疗乙型肝炎肝硬化并发食管静脉曲张患者疗效研究OACSTPCD
Effect of balloon-compression endoscopic injection sclerotherapy in the treatment of patients with decompensated stage of hepatitis B cirrhosis and esophageal varices
目的 探讨球囊压迫辅助下内镜硬化剂注射术(bc-EIS)治疗乙型肝炎肝硬化并发食管静脉曲张(EV)患者的疗效.方法 2020 年1 月～2022 年1 月我院诊治的78 例失代偿期乙型肝炎肝硬化并发EV患者,被随机分为对照组39 例和观察组39 例,分别给予内镜下EV套扎术(EVL)治疗或bc-EIS治疗,术后随访 1 年.使用超声检测门静脉内径(PVD)、门静脉流速(PVV)、脾静脉内径(SVD)和脾静脉流速(SVV).结果 在首次治疗后3 个月内,观察组EV根除率为100.0%,显著高于对照组的89.7%(x2=4.216,P=0.040);观察组EV根除次数、累计住院时间和治疗费用分别为(1.6±0.3)次、(7.7±1.0)d和(1.9±0.6)万元,显著少于或短于对照组[分别为(2.4±0.5)次、(10.1±1.3)d和(2.6±0.7)万元,P<0.05];治疗前后,两组PVD、PVV、SVD和SVV变化无显著性差异(P>0.05);治疗后,观察组食管溃疡发生率为35.9%,显著高于对照组的17.9%(P<0.05);在随访12m时,观察组病死率为15.4%,与对照组的23.1%比,无显著性差异(P>0.05).两组生存患者比较,观察组EV复发和EVB发生率分别为3.0%和6.1%,显著低于对照组(分别为26.7%和33.3%,P<0.01).结论 bc-EIS可通过改善门静脉及脾静脉血流动力学提升失代偿期乙型肝炎肝硬化并发EV患者疗效,降低EV复发和再出血发生几率,且能够减轻患者经济负担,有一定临床推广价值.
Objective The purpose of this study was to investigate the effect of balloon-compression endoscopic injection sclerotherapy(bc-EIS)in the treatment of patients with decompensated stage of hepatitis B cirrhosis and esophageal varices(EV),and the impact on rebleeding rate.Methods 78 patients with decompensated stage of hepatitis B cirrhosis and EV were diagnosed and treated in our hospital between January 2021 and January 2022.All of them were given conventional treatments such as acid suppression,hemostasis and blood transfusion.Among them,39 patients received endoscopic variceal ligation(EVL)(control group)and 39 patients received bc-EIS(observation group).All patients were followed up for twelve months.Curative effect,treatment indicators,adverse reactions and prognosis were compared between the groups.Ultrasound was used to measure portal vein diameter(PVD),portal vein velocity(PVV),splenic vein diameter(SVD)and splenic vein velocity(SVV).Results The first variceal eradication rate and esophageal varices eradication rate after 1 to 2 times in the observation group were 87.2%and100.00%,significantly higher than that in the control group(66.7%and89.7%,P<0.05).The number of treatments,hospitalization time,and treatment costs for achieving EV eradication in the observation group were(1.6±0.3)times,(7.7±1.0)days and(19±6)thousand yuan,lower than those in the control group[(2.4±0.5)times,(10.1±1.3)days,and(26±7)thousand yuan,P<0.05].During the 6 months of follow-up,PVV and SVV in the observation group were(19.04±2.12)cm/s and(21.35±2.25)cm/s,significantly higher than those in the control group[(22.49±2.37)cm/s and(19.58±2.61)cm/s,P<0.05)].The incidence of esophageal ulcers in the observation group was 35.9%,significantly higher than the control group(17.9%,P<0.05).During the 6 months of follow-up,the recurrence rate and rebleeding rate of EV in the observation group were 2.7%and 2.7%,significantly lower than that in the control group(20.0%and 22.9%,P<0.05).During the 12 months of follow-up,the recurrence rate and rebleeding rate of EV in the observation group were 3.0%and 6.1%,significantly lower than that in the control group(26.7%and 33.3%,P<0.05).Conclusion bc-EIS can improve curative effect on hepatitis B cirrhosis with EV,reduce the incidence of EV recurrence and rebleeding by improving portal and splenic venous hemodynamics,and alleviate the economic burden on patients.
赵维波;王源;孔令甲;朱玉森;岳宗柱;商西单
252600 山东省聊城市第二人民医院消化内科山西医科大学第二附属医院内镜室
肝硬化食管静脉曲张球囊压迫内镜下硬化剂注射术内镜下曲张静脉套扎术治疗
Decompensated stage of hepatitis B cirrhosisEsophageal varicesBalloon compressionEndoscopic injection sclerotherapyRebleeding rateTreatment
《实用肝脏病杂志》 2024 (004)
559-562 / 4
山东省医药卫生科技发展计划项目(编号:202103010807)
评论