内镜下硬化剂和组织胶注射联合套扎术治疗直肠异位静脉曲张破裂出血的临床效果

Clinical effect of endoscopic sclerosing agent and tissue glue injection combined with ligation for the treatment of rectal ectopic varices bleeding

摘要:

目的 探讨内镜下硬化剂和组织胶注射联合套扎术治疗直肠异位静脉曲张（EV）破裂出血的临床效果。方法 回顾性分析2017年1月－2022年1月在该院消化内科接受内镜治疗的60例直肠EV破裂出血患者的临床资料，根据手术方式不同，将患者分为两组。其中，对照组30例，采用内镜下套扎术治疗；观察组30例，采用内镜下硬化剂和组织胶注射联合套扎术治疗。术后1、3、6和12个月进行随访，比较两组患者手术止血成功率、术后并发症发生率、死亡率、术后曲张静脉直径改善情况和术后有效率。结果 观察组手术止血成功率为93.3%，明显高于对照组的66.7%，观察组腹痛和发热发生率分别为10.0%和10.0%，明显低于对照组的33.3%和36.7%，观察组死亡率为6.7%（2/30），明显低于对照组的30.0%（9/30），观察组术前曲张静脉直径为（1.60±0.36）cm，术后直径不断缩小，术后12个月直径为（0.78±0.31）cm，对照组术前曲张静脉直径为（1.52±0.26）cm，术后直径不断增加，术后12个月直径为（1.55±0.36）cm，观察组术后曲张静脉直径改善情况明显优于对照组，观察组术后治疗有效率明显高于对照组，差异均有统计学意义（P < 0.05）。结论 内镜下硬化剂和组织胶注射联合套扎术治疗直肠EV破裂出血，手术止血成功率和治疗有效率更高，且术后并发症更少，死亡率更低，临床疗效满意，值得临床推广应用。

Abstract:

Objective To explore the clinical effect of endoscopic sclerosing agent and tissue glue injection combined with ligation in the treatment of rectal ectopic varices (EV) bleeding.Method A retrospective analysis was conducted on 60 patients with rectal EV bleeding who received endoscopic treatment from January 2017 to January 2022. According to the surgical method, the patients were divided into two groups, with 30 cases in the control group receiving endoscopic ligation treatment; 30 cases in the observation group were treated with endoscopic scleroing agent and tissue glue injection combined with ligation. Follow up was conducted according to a cycle of 1, 3, 6 and 12 months after surgery, and the following indicators were compared between the two groups of patients: successful surgical hemostasis rate, incidence of postoperative complications, mortality rate, improvement of postoperative varicose vein diameter, and postoperative response rate.Result The success rate of surgical hemostasis in the observation group was 93.3%, significantly higher than 66.7% in the control group, the incidence of abdominal pain and fever in the observation group was 10.0% and 10.0%, respectively, significantly lower than 33.3% and 36.7% in the control group, there were 2 deaths in the observation group and 9 deaths in the control group, the mortality rate in the observation group was 6.7%, significantly lower than the 30.0% in the control group, the preoperative venous diameter of the observation group was (1.60 ± 0.36) cm, and the postoperative diameter continued to decrease, at the 12th month after surgery, the diameter was (0.78 ± 0.31) cm, while in the control group, the preoperative venous diameter was (1.52 ± 0.26) cm, the postoperative diameter continued to increase, and at the 12th month after surgery, the diameter was (1.55 ± 0.36) cm, the postoperative effective rate of the observation group was significantly better than that of the control group, the differences were statistically significant (P < 0.05).Conclusion The combination of endoscopic scleroing agent and tissue glue injection combined with ligation for the treatment of rectal EV bleeding has a higher success rate and effective rate of surgical hemostasis, fewer postoperative complications, lower mortality rate during follow-up observation, and satisfactory clinical efficacy. It is worth further promoting and applying in clinical practice.