标题：内镜联合药物诊治肝硬化食管胃底静脉曲张破裂出血的疗效及再出血危险因素研究

      作者：叶营，孙相钊，蔡春调，张俐，莫如聪    (廉江市人民医院消化内科，广东 廉江 524400)

      卷次： 2017年28卷3期

      【摘要】 目的 探讨肝硬化食管胃底静脉曲张破裂出血(EGVB)内镜联合药物诊治的效果及再出血危险因素。方法 选取2011年1月至2015年7月期间在廉江市人民医院消化内科治疗的114例肝硬化EGVB患者作为研究对象。采用内镜下食管静脉曲张套扎术联合内镜下静脉曲张硬化注射术(EIS)治疗食管静脉曲张出血，采用组织黏胶内镜注射联合EIS治疗胃底静脉曲张出血，同时所有患者均给予生长抑素和心得安治疗。统计静脉曲张类型、疗效和并发症情况。根据止血成功后是否再出血把患者分为未出血组和再出血组，统计两组的再出血危险因素。采用行×列表χ2检验及其分割法和多因素Logistic回归分析等分析相关数据。结果 所有患者均止血成功，止血成功率为100.00%。1型食管胃静脉曲张（GOVl）、2型食管胃静脉曲张(GOV2)、GOVl+GOV2的静脉曲张消失率分别为93.55%、66.67%、68.57%，其中GOVl的静脉曲张消失率明显高于其他两种类型，差异圴有统计学意义(P<0.05)；GOVl、GOV2、GOVl+GOV2的静脉曲张复发率分别为9.68%、35.42%、37.14%，其中GOVl的静脉曲张复发率明显低于其他两种类型，差异圴有统计学意义(P<0.05)；门静脉内径、Child-Pugh评分是再出血的独立危险因素，而白蛋白浓度和血钠浓度是保护因素。结论 内镜联合药物诊治肝硬化EGVB的效果明确，其中以GOVl的疗效最为显著。影响肝硬化EGVB再出血的因素众多。
      【关键词】 食管胃底静脉曲张；出血；套扎术；硬化注射术；组织黏胶；生长抑素；危险因素
      【中图分类号】 R575.2 【文献标识码】 A 【文章编号】 1003—6350（2017）03—0374—05

Efficacy of endoscopic surgery combined with drug therapy in the treatment of esophageal and gastric varicesbleeding and risk factors of rebleeding.
YE Ying, SUN Xiang-zhao, CAI Chun-tiao, ZHANG Li, MO Ru-cong.Department of Gastroenterology, the People's Hospital of Lianjiang, Lianjiang 524400, Guangdong, CHINA
【Abstract】 Objective To investigate the efficacy of endoscopic surgery combined with drug therapy in thetreatment of esophageal and gastric varices bleeding (EGVB) and risk factors of rebleeding. Methods A total of 114 pa-tients of EGVB, who admitted to Department of Gastroenterology of the People's Hospital of Lianjiang from January2011 to July 2015, were selected as the research objects. Esophageal variceal bleeding was diagnosed and treated withendoscopic variceal ligation and endoscopic injection sclerotherapy (EIS), and gastric fundus varices bleeding was diag-nosed and treated with endoscopic tissue glue injection and EIS. Each patient was treated with somatostatin and propran-olol at the same time. The type of varicose vein, curative effect, and complication were statistically analyzed. The pa-tients were divided into the no-bleeding group and rebleeding group depending on whether rebleeding. The risk factorsof rebleeding in the two groups were statistically analyzed. The data were analyzed by R×C Chi square test and multiplelogistic regression analysis. Results All patients had successful hemostasis with a success rate of 100.00%. The disap-pearance rate of varicose vein in the gastroesophngeal varioes type 1 (GOVl), gastroesophageal varices type 2 (GOV2),GOVl+GOV2 were 93.55%, 66.67%, 68.57%, respectively; the disappearance rate of varicose vein of GOVl was signifi-cantly higher than that of the other two types (P<0.05). The recurrence rates of varicose vein in the GOVl, GOV2,GOVl+GOV2 were 9.68%, 35.42% and 37.14%, respectively; the recurrence rates of varicose vein of GOVl was signifi-cantly lower than that of the other two types (P<0.05). The inner diameter of portal vein and Child-Pugh score were theindependent risk factors for rebleeding, while albumin concentration and serum sodium concentration were the protec-tive factors of rebleeding. Conclusion The efficacy of endoscopic surgery combined with drug therapy in the treatmentof EGVB is clear, of which the efficacy for GOVl was the most significant. There are many factors influencing rebleed-ing of EGVB in liver cirrhosis patients.
      【Key words】 Esophageal and gastric varices bleeding (EGVB); Bleeding; Ligation; Injection sclerotherapy; Tis-sue glue; Somatostatin; Risk factors·论 著·doi:10.3969/j.issn.1003-6350.2017.03.010基金项目：广东省医学科研基金项目（编号：A2014766）