摘要
目的探讨组织黏合剂在食管-胃静脉曲张破裂出血(esophageal-gastric variceal bleeding,EGVB)急诊止血治疗中的有效性及安全性。方法回顾性分析作者单位2017年1月—2020年6月共68例施行急诊内镜止血治疗的EGVB患者,其中组织黏合剂注射组(A组)43例,静脉套扎治疗组(B组)25例,比较两组的内镜操作时间、急诊止血成功率、术后再出血率、并发症发生率、死亡率等数据。结果采用多学科诊疗(MDT)模式,68例EGVB患者全部止血成功,急诊止血成功率100%。两组急诊止血率和胃镜操作时间无统计学差异(P>0.05)。A、B两组术后各1例死亡,死亡率比较无统计学差异(P>0.05)。术后4 d~2周内再出血A组0例而B组3例;术后3~24周内再出血A组1例、B组4例;并发症方面A组腹痛1例、发热2例,B组胸骨后吞咽疼痛10例。术后4 d~2周及3~24周的再出血率及术后并发症发生率A组均低于B组(χ^(2)=5.3982,P=0.0202;χ^(2)=4.3394,P=0.0372;χ^(2)=9.1160,P=0.0025)。结论MDT模式是EGVB救治的有力保障。EGVB患者用组织黏合剂经胃镜曲张静脉注射止血,安全、可靠、快捷,值得在急诊临床中推广。
Objective To discuss the effectiveness and safety of tissue adhesive glue in treatment of acute esophageal gastric variceal bleeding(EGVB).Methods 68 cases from Jan 2017 to Jun 2020 with cirrhosis accompanying acute esophageal gastric variceal bleeding of our hospital,were restrospecively analyzed,the emergency response rate、re bleeding rate、incidence of complications after the treatment and death rate were compared.Among them,43 cases were gave therapy with tissue adhesive glue;25 cases were treated with gastroscopy variceal ligation.Results The multi-dis⁃ciplinary team(MDT)diagnosis and treatment mode was adopted.Hemostasis was successful in all of the 68 patients with EGVB,with 100%success rate in emergency hemostasis.There was no statistically significant difference in the emergency hemostasis rate and gastroscopy operation time between the two groups(P>0.05).One patient died postopera⁃tively in each group,There was no statistically significant difference in mortality(P>0.05).Rebleeding within 4 d-2 weeks after surgery occurred in 0 patients in group A compared with 3 patients in group B.Rebleeding within 3-24 weeks after surgery occurred in 1 patient in group A and 4 patients in group B.Complication aspects there were 1 pa⁃tient with abdominal pain,2 patients with fever in group A,and 10 patients with post sternal swallowing pain in group B.Rebleeding rates at 4 d-2 weeks and 3-24 weeks after surgery and postoperative complication rates were lower in group A than in group B(χ^(2)=5.3982,P=0.0202;χ^(2)=4.3394,P=0.0372;χ^(2)=9.1160,P=0.0025).Conclusion The multi-disciplinary diagnosis and treatment team of gastrointestinal hemorrhage is a powerful guarantee of safety and ef⁃ficiency.It is safe,reliable and quick for EGVB patients to use tissue adhesive to stop bleeding through gastroscopic varicose vein injection,which is worthy of promotion in emergency clinic.
作者
胡明辉
范合璋
罗东霞
HU Minghui;FAN Hezhang;LUO Dongxia(Public Health Clinical Center of Chengdu,Chengdu Sichuan 610061,China)
出处
《中国急救复苏与灾害医学杂志》
2021年第8期911-914,932,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
四川省科学技术厅基础平台项目(编号:2017TJPT0013)。
关键词
肝硬化
食管胃静脉曲张
上消化道出血
内镜治疗
组织黏合剂
Hepatocirrhosis
Esophageal and gastric varices
Upper gastrointestinal bleeding
Endoscopic therapy
Tis⁃sue adhesive glue
