食管胃连通性静脉曲张内镜下精准断流术复治时间选择的临床研究

背景:肝硬化食管胃静脉曲张破裂出血是临床常见危急重症,消化道内镜治疗对于控制出血和预防再出血具有重要作用。目的:探讨食管胃连通性静脉曲张患者行内镜下精准曲张静脉断流术(ESVD)复治时间的选择。方法:金华市中心医院于2018年10月—2019年9月收治的48例有出血史的肝硬化食管胃连通性静脉曲张患者纳入研究。患者于ESVD初治后随机进入2周复治组(A组)和4周复治组(B组),术后随访6个月,比较两组曲张静脉根除疗效以及再出血率和死亡率。结果:A组和B组曲张静脉根除显效率分别为76.9%和81.8%,差异无统计学意义(P>0.05)。A组术后6个月内再出血率显著低于B组(11.5%对36.4%,P<0.05),两组随访期间均无患者死亡。结论:ESVD用于食管胃连通性静脉曲张破裂出血的二级预防效果明显。在复治时间选择方面,短期(2周)复治能更早处理高危易出血血管,从而降低再出血率。

Clinical Study on Timing of Re-treatment of Endoscopic Selective Varices Devascularization for Esophageal and Gastric Varices(Sarin Type GOV1 and GOV2)

Background:Liver cirrhosis complicated with esophageal and gastric variceal bleeding is a commonly seen critical illness.Gastrointestinal endoscopy is widely applied for bleeding control and prevention of rebleeding.Aims:To investigate the timing of re-treatment of endoscopic selective varices devascularization(ESVD)for treatment of esophageal and gastric varices presenting as Sarin type GOV1 and GOV2.Methods:Forty-eight cirrhotic patients with GOV1 or GOV2 varices and a history of bleeding admitted from October 2018 to September 2019 at Jinhua Municipal Central Hospital were enrolled and underwent ESVD therapy for secondary prevention.After the first ESVD procedure,patients were randomly allocated into two groups,and received the re-treatment 2 weeks(Group A)and 4 weeks(Group B)later,respectively.All patients were followed up for 6 months and the efficacy of ESVD,as well as the rebleeding rate and the mortality rate were compared between the two groups.Results:There was no significant difference in devascularization of varicose veins between Group A and Group B(76.9%vs.81.8%,P>0.05).The incidence of rebleeding in Group A was significantly lower than that in Group B during the 6-month follow-up(11.5%vs.36.4%,P<0.05).No death occurred in both groups.Conclusions:ESVD is effective for secondary prevention of GOV1 and GOV2 variceal bleeding.With regard to the timing of re-treatment,short-term(2 weeks postoperatively)re-treatment might reduce the probability of rebleeding because it could deal with the high risk and vulnerable bleeding vessels earlier.