CAJ | 학술논문

目的分析内镜下静脉曲线套扎治疗( gastric variceal ligation ,GVL)和组织黏合剂内镜下静脉曲线栓塞术( gastric variceal obturation ,GVO)两种方法对胃静脉曲张的疗效,比较和评价两种内镜下治疗方法对胃静脉曲张的治疗效果,为临床治疗胃静脉曲张提供参考. 方法选择2010 年1月至2013年12月经西安交通大学第二附属医院消化内科和感染科住院治疗的胃静脉曲张患者93例,其中48例接受GVL治疗,45例接受GVO治疗,随访两组患者的临床和内镜下资料,比较分析两种治疗方法的曲张静脉消除率、曲张静脉复发率、初始止血成功率、再出血率、死亡率和并发症发生率,从而评价两种方法对胃静脉曲张的治疗效果.结果 GVL组和GVO组最终达到胃静脉曲张消除的患者分别为64.6%和62.2%,无显著性差异(P=0.813). 两种方法对胃静脉曲张急性出血的止血成功率均较高且无显著性差异(GVL组91.7%,GVO组100%,P>0.05). GVL和GVO治疗后分别有31.3%和26.7%的患者发生再出血,总体再出血率无显著性差异(P=0.672). Kaplan-Meier分析显示两组的累积再出血率也无显著性差异(P=0.582). 但对于1型孤立性胃静脉曲张,GVO组的再出血率低于GVL组(P=0.037). 两种治疗方法术后并发症的发生率及死亡率的差异无统计学意义(P>0.05),累积生存率亦无显著性差异(P=0.350). GVO治疗和GVL治疗对胃静脉曲张的消除效果无显著性差异. 在控制胃静脉曲张急性出血方面,GVL和GVO的疗效相当,且术后并发症发生率和死亡率无显著性差异.结论 GVO治疗胃静脉曲张是一种安全有效的方法,但仍需注意栓塞并发症尤其是系统栓塞并发症的发生. GVL可作为胃静脉曲张治疗的一种选择,尤其对于GOV1 型和GOV2型治疗效果较好.
목적 분석내경하정맥곡선투찰치료( gastric variceal ligation ,GVL)화조직점합제내경하정맥곡선전새술( gastric variceal obturation ,GVO)량충방법대위정맥곡장적료효,비교화평개량충내경하치료방법대위정맥곡장적치료효과,위림상치료위정맥곡장제공삼고. 방법 선택2010 년1월지2013년12월경서안교통대학제이부속의원소화내과화감염과주원치료적위정맥곡장환자93례,기중48례접수GVL치료,45례접수GVO치료,수방량조환자적림상화내경하자료,비교분석량충치료방법적곡장정맥소제솔、곡장정맥복발솔、초시지혈성공솔、재출혈솔、사망솔화병발증발생솔,종이평개량충방법대위정맥곡장적치료효과.결과 GVL조화GVO조최종체도위정맥곡장소제적환자분별위64.6%화62.2%,무현저성차이(P=0.813). 량충방법대위정맥곡장급성출혈적지혈성공솔균교고차무현저성차이(GVL조91.7%,GVO조100%,P>0.05). GVL화GVO치료후분별유31.3%화26.7%적환자발생재출혈,총체재출혈솔무현저성차이(P=0.672). Kaplan-Meier분석현시량조적루적재출혈솔야무현저성차이(P=0.582). 단대우1형고립성위정맥곡장,GVO조적재출혈솔저우GVL조(P=0.037). 량충치료방법술후병발증적발생솔급사망솔적차이무통계학의의(P>0.05),루적생존솔역무현저성차이(P=0.350). GVO치료화GVL치료대위정맥곡장적소제효과무현저성차이. 재공제위정맥곡장급성출혈방면,GVL화GVO적료효상당,차술후병발증발생솔화사망솔무현저성차이.결론 GVO치료위정맥곡장시일충안전유효적방법,단잉수주의전새병발증우기시계통전새병발증적발생. GVL가작위위정맥곡장치료적일충선택,우기대우GOV1 형화GOV2형치료효과교호.
Objective To analyze and evaluate the efficacy of gastric variceal ligation ( GVL) and gastric variceal obturation ( GVO) for patients with gastric varices , accordingly providing some reference for the clinical treatment of gastric varices .Methods Ninty-three patients with gastric varices were included at the Second Affiliated Hospital of Xi′an Jiaotong University from January 2010 to December 2013 .Among them,48 patients received GVL and 45 received GVO.Recording clinical and endscopic change after treatment, we compared elimination coefficient , recurrence rate and rebleeding rate , mortality and complications between two groups ( GVL and GVO) .By comparing the above items ,we finally evaluated the efficacy of GVL and GVO for gastric varices .Results In patients who received GVL , 64.6% of them achieved obliteration of varicose veins , while 62.2% with GVO.There was no significant difference between two groups (P=0.813).GVL and GVO were both effective in controlling acute gastric varices bleeding,and the difference between two methods had no statistical significance (GVL 91.7%,GVO 100%, P>0.05).Rebleeding occurred in 31.3%patients in the GVL group and 26.7%in the GVO group (P=0.672).The rebleeding rate was still higher in IGV1 petients compared with GOV1 and GOV2 ( P =0.037).Complications and mortality rates showed no significant difference between the groups ( P =0.608),as well as cumulative survival rates (P=0.350).The efficacy of GVL to obliterate gastric varices is similar to GVO.The ability of GVL to control active gastric variceal bleeding showed no difference to GVO, as well as complications and survival .Conclusions GVO is a safe and effective method for gastric varices, while it still needs to be aware of the occurrence of embolic complications especially systematic embolic complications .GVL is a feasible strategy to handle gastric varices , particularly for GOV1 and GOV2.