改良三明治法同步与序贯联合套扎治疗食管胃底静脉曲张的疗效比较*

Comparison of injecting tissue glue and lauromacrogol in modified sandwich method with synchronization or sequential ligation for esophageal and gastric variceal*

摘要:

目的??探讨改良三明治法同步与序贯联合套扎治疗食管胃底静脉曲张（EGV）的疗效。方法?42例EGV患者随机分为同步治疗组（22例）和序贯治疗组（20例），同步治疗组采用内镜下改良三明治法治疗胃底曲张静脉后，同时行食管曲张静脉套扎术（EVL），序贯治疗组采用内镜下改良三明治法治疗胃底曲张静脉后，隔一周分次行EVL。比较两组患者内镜下止血成功率、再出血率、胃底静脉曲张（GV）改善率、套扎器应用数目及腹痛、发热、菌血症和异位栓塞等不良反应发生率。结果?两组患者内镜下止血成功率、再出血率、GV改善率差异无统计学意义，两组患者胸腹痛、发热、菌血症发生率差异无统计学意义。所有患者均未出现异位栓塞。两组患者分别平均应用（8.19±2.01）与（7.81±1.78）枚套扎环，食管静脉曲张（EV）消失率分别为59.09%与70.00%，差异均无统计学意义（P >0.05）。结论?内镜下一次性注射组织胶+聚桂醇同步联合套扎治疗EGV安全有效，并发症发生率低，且可减少内镜检查次数，减少患者痛苦及医疗费用，值得进一步研究。

Abstract:

Objecive?To evaluate and compare the efficacy of injecting tissue glue and lauromacrogol in modified sandwich method combined with synchronous ligation for patients with esophageal and gastric variceal.?Methods?42 cases of patients with esophageal and gastric variceal were randomly divided into synchronous treatment group (22 cases) and sequential treatment group (20 cases). Both group received modified sandwich method for gastric varices (lauromacrogol-tissue adhesive-lauromacrogol). Synchronous treatment group meanwhile received synchronization ligation for esophageal varices, but sequential treatment group received sequential ligation after one week. The hemostasis rate, effective rate of varices, rebleeding and complications rate were analyzed.?Results?There were no significant difference in hemostasis rate, effective rate and rebleeding rate between two groups. The incidence of complications, such as chest and abdominal pain, fever, transient bacteremia were equal between these two groups. No patients had ectopic embolism. The number of ligation device in synchronous treatment group was more than sequential treatment group (8.19 ± 2.01 vs 7.81 ± 1.78, P > 0.05), and the rate of esophageal varices disappearance was inferior to sequential treatment group (59.09% vs 70.00%), however, there were no statistical difference (P > 0.05).?Conclusion?Endoscopic injection of tissue glue and lauromacrogol synchronization ligation is safe and effective for esophageal and gastric variceal with low complication rates. This method could reduce gastroscopy times and medical expenses, and is worthy of further investigating.