内镜序贯治疗儿童门静脉高压症伴食管胃静脉曲张破裂出血的疗效观察

Efficacy of endoscopic sequential therapy for esophagogastric variceal bleeding in pediatric portal hypertension

摘要:

目的 评估内镜序贯治疗儿童门静脉高压症（PHT）伴食管胃静脉曲张破裂出血（EVB）的临床疗效。方法 回顾性分析2010年6月－2023年2月于该院内镜下序贯治疗的PHT伴EVB的患儿21例。收集患儿病史特点、内镜表现、疗效和术后生长发育情况，分析所需内镜次数、术后即刻止血率、术后再出血率、术后并发症、生存率和术后长期生长发育情况。结果 患儿平均年龄（6.86±2.95）岁。末次治疗前血红蛋白水平明显高于首次入院，差异有统计学意义（P < 0.01）。共行81次（105项次）内镜下治疗，21例患者接受治疗次数的中位数为4.00（1.00，10.00）次。其中，18例患者接受内镜下套扎治疗，每例次套扎环数为7.0（6.00，12.00）环。内镜下硬化剂注射（EIS）治疗18例，每例次硬化剂用量为（12.29±5.67）mL。内镜下组织黏合剂注射治疗19例，每例次组织胶用量为（2.96±1.24）mL。内镜下即刻止血率为100.00%。6个月内再出血率为4.76%（1/21），6个月以上再出血率为14.28%（3/21）。至随访结束，4例患儿成年，体重指数（BMI）均在正常范围之内；其余17例未成年患儿年龄别体重Z评分（WAZ评分）明显改善（P < 0.01）。结论 内镜序贯治疗儿童PHT伴EVB安全、有效，促进患儿生长发育的同时，可作为外科手术后的补救措施，还可为未手术者提供手术或肝移植的机会。

Abstract:

Objective To evaluate the clinical efficacy of sequential endoscopic treatment for children with portal hypertension (PHT) accompanied by esophagogastric variceal bleeding (EVB).Methods A retrospective analysis was conducted on 21 children with PHT accompanied by EVB who received sequential endoscopic treatment in this hospital from June 2010 to February 2023. The medical history, endoscopic manifestations, efficacy, and postoperative growth and development of the children were collected, and the required number of endoscopes, immediate hemostasis rate, rebleeding rate, postoperative complications, postoperative survival rate, and long-term growth and development were analyzed.Results The average age of the patients was (6.86 ± 2.95) years. The hemoglobin level before the last treatment was significantly higher than that at the first admission, and the difference was statistically significant (P < 0.01). 81 endoscopic treatments (105 sessions) were performed, and the median number of treatments received by 21 patients were 4.00 (1.00, 10.00) times. Among them, 18 patients received endoscopic ligation treatment, and the number of ligation rings in each case was 7.00 (6.00, 12.00) rings. Eighteen cases were treated with endoscopic injection sclerotherapy (EIS), and the dosage of sclerosing agent for each case was (12.29 ± 5.67) mL. Nineteen cases were treated with endoscopic tissue adhesive injection, and the dosage of tissue adhesive for each case was (2.96 ± 1.24) mL. The immediate hemostasis rate under endoscopy was 100.00%. The rebleeding rate within 6 months was 4.76% (1/21), and the rebleeding rate after 6 months was 14.28% (3/21). By the end of the follow-up, 4 children had reached adulthood, and their body mass index (BMI) was all within the normal range. The weight for age Z score (WAZ) of the remaining 17 underage children improved significantly (P < 0.01).Conclusion Endoscopic sequential treatment of PHT with EVB in children is safe and effective. While promoting the growth and development of children, it can also serve as a remedial measure after surgical operation and provide surgical or liver transplantation opportunities for those who have not undergone surgery.