急诊胃镜下套扎术、硬化术和组织胶注射术治疗食管胃交界区静脉曲张破裂出血效果分析

目的探讨急诊胃镜下套扎术(EVL)、硬化术(EIS)和组织胶注射术(HI)在食管胃交界区静脉曲张破裂出血治疗中的有效性和安全性,以及不同止血方法的合理选择。方法选取2017年6月-2019年6月北京世纪坛医院和解放军总医院第五医学中心急诊胃镜止血治疗的肝硬化食管胃交界区静脉曲张破裂出血患者共1264例,按照急诊胃镜下不同止血方法进行分组,比较EVL组、EIS组、HI组间的操作成功率、止血成功率、早期再出血率及术后并发症;依据出血位置进行再分类,比较不同出血部位不同止血方法的止血成功率。计量资料3组间比较采用方差分析,计数资料3组间比较采用χ2检验。结果不同止血方法组间操作成功率差异显著(χ2=75.01,P<0.05),EIS、HI操作成功率明显高于EVL,EIS高于HI(P值均<0.05)。不同止血方法组间止血成功率差异显著(χ2=9.885,P<0.05),HI止血成功率高于EVL及EIS(P值均<0.05)。不同组间术后早期再出血率差异无统计学意义(χ2=0.290,P=0.865)。不同组间术后并发症比较,术后误吸并发肺炎、发热、胸骨后不适差异显著(χ2值分别为19.08、23.94、19.56,P值均<0.05);EVL术后误吸并发肺炎的发生率高于EIS、HI,HI术后发热比例高于EVL、EIS,EVL、HI术后胸骨后不适发生率高于EIS,差异均有统计学意义(P值均<0.05)。食管胃交界线(EGJ)线上1~5 cm内EIS、EVL止血成功率高;EGJ线上1 cm至线下2 cm内EIS与HI止血成功率无明显差异;EGJ线下2~5 cm内HI止血成功率高。结论EVL、EIS、HI为治疗食管胃交界区静脉曲张破裂出血有效方法,依据出血位置合理选择止血方法可提高止血疗效。

Clinical effect of emergency gastroscopic ligation,sclerotherapy,and tissue adhesive injection in treatment of esophagogastric junctional variceal bleeding

Objective To investigate the clinical effect of endoscopic variceal ligation(EVL),endoscopic injection sclerotherapy(EIS),and tissue adhesive injection in the treatment of esophagogastric junctional variceal bleeding,and to provide a reference for reasonable selection of different hemostasis methods.Methods A total of 1264 patients with liver cirrhosis and esophagogastric junctional variceal bleeding who underwent emergency gastroscopic hemostasis in Beijing Shijitan Hospital and The Fifth Medical Center of Chinese PLA General Hospital from June 2017 to June 2019 were enrolled and divided into EVL,EIS,HI groups based on the method of emergency gastroscopic hemostasis.These groups were compared in terms of success rate of operation,success rate of hemostasis,early rebleeding rate,and postoperative complications.The patients were also divided into groups based on bleeding site,and the success rates of different hemostasis methods at different sites were compared.An analysis of variance was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.Results The success rate of EIS and tissue adhesive injection was significantly higher than that of EVL,and the success rate of EIS was significantly higher than that of tissue adhesive injection(χ2=75.01,P<0.05).Tissue adhesive injection had a significantly higher success rate of hemostasis than EVL and EIS(χ2=9.885,P<0.05).There was no significant difference in early rebleeding rate between groups(χ2=0.29,P=0.865).The patients undergoing EVL had a significantly higher incidence rate of aspiration and pneumonia than those undergoing EIS or tissue adhesive injection(χ2=19.08,P<0.05);the patients undergoing tissue adhesive injection had a significantly higher proportion of patients with postoperative pyrexia than those undergoing EVL or EIS(χ2=23.94,P<0.05);the patients undergoing EVL or tissue adhesive injection had a significantly higher incidence rate of postoperative retrosternal discomfort than those undergoing EIS(χ2=19.56,P<0.05).EIS and EVL had a high success rate of hemostasis for the bleeding sites at 1-5 cm above the esophagogastric junction(EGJ);EIS and tissue adhesive injection had a similar success rate of hemostasis for the bleeding sites from 1 cm above the EGJ to 2 cm below the EGJ;tissue adhesive injection had a high success rate of hemostasis for the bleeding sites at 2-5 cm below the EGJ.Conclusion EVL,EIS,and tissue adhesive injection are effective methods for the treatment of esophagogastric junctional variceal bleeding,and the selection of hemostasis method based on the location of bleeding site can improve the outcome of hemostasis.