聚桂醇和血凝酶局部注射联合密集套扎治疗肝硬化伴食管静脉曲张破裂出血的临床研究

Clinical study in treatment of esophageal variceal bleeding with local injection of lauromacrogol and hemagglutinin combined with dense variceal ligation

摘要:

目的 探讨聚桂醇和血凝酶局部注射并联合密集套扎法治疗肝硬化伴食管静脉曲张破裂出血（EVB）的临床疗效。方法 选取2016年2月－2019年12月在该科住院的肝硬化伴EVB患者45例，随机分为两组。对照组（n = 21）采用密集套扎治疗，治疗组（n = 24）在密集套扎治疗的基础上，再在每两个结扎点曲张静脉内注射混合液（聚桂醇10.0 mL+血凝酶2 u）1.0～2.0 mL，一般注射5～10个点。30 d后再行第２次胃镜检查，必要时再行上述治疗，直到所有曲张静脉完全消除。结果 治疗组术后6个月食管静脉曲张清除率优于对照组（83.33%和52.38%，P < 0.05）。治疗组复发率明显低于对照组，两组比较，差异有统计学意义（P < 0.05）。治疗组脱痂期术后出血率低于对照组（0.00%和19.05%，P < 0.05）。两组首次内镜下治疗失败率、术后发热率、术后胸骨后疼痛发生率和术后半年死亡率比较，差异均无统计学意义（P > 0.05）。结论 采用聚桂醇和血凝酶局部注射联合密集套扎治疗肝硬化伴EVB，具有较好的临床疗效，患者获益大，可作为推荐术式之一。

Abstract:

Objective To investigate the clinical efficacy of local injection of cinnamyl alcohol and hemagglutinin combined with dense esophageal variceal ligation (DEVL) in treatment of cirrhosis with esophageal variceal bleeding (EVB).Methods 45 patients of liver cirrhosis and esophageal varicose rupture and bleeding from Feb 2016 to Dec 2019 were randomly divided into two groups. 21 patients in control group were treated with DEVL. On the basis of DEVL, 24 patients in treatment group were intravenously injected with 1.0~2.0 mL mixed solution (lauromacrogol 10.0 mL + hemagglutinin 2 u) at every two ligation points and there were usually 5~10 points in total. A second gastroscopy was performed after 30 days, and the above treatments were performed when necessary, until all varicose veins were completely eliminated.Results The clearance rate of esophageal varices in the treatment group was better than that in the control group (83.33% vs 52.38%, P < 0.05) in 6 months after the treatment was done. In term of the recurrence rate of esophageal varices, the treatment group was significantly lower than that in the control group. The treatment group presented a significantly lower bleeding rate during decrustation period than the control group in cases of esophageal varices recurrence (0.00% vs 19.05%, P < 0.05). There were no significant differences in first-time endoscopic treatment failure rate, postoperative fever rate, incidence of postoperative retrosternal pain and the post-operation half-year mortality between the two groups (P > 0.05).Conclusion Local injection of cinnamyl alcohol and hemagglutinin combined with DEVL may substantially benefit the patients of liver cirrhosis and esophageal varices, as its clinical efficacy appears rather significant. Thus, it may be recommended as one of treatment schemes available.