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姜思雨，杨凯奇，黄晓铨，等. 内镜下套扎用于肝硬化胃静脉曲张出血二级预防的效果及安全性[J]. 中国临床医学, 2024, 31(3): 367-373. DOI: 10.12025/j.issn.1008-6358.2024.20240635
引用本文: 姜思雨，杨凯奇，黄晓铨，等. 内镜下套扎用于肝硬化胃静脉曲张出血二级预防的效果及安全性[J]. 中国临床医学, 2024, 31(3): 367-373. DOI: 10.12025/j.issn.1008-6358.2024.20240635
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JIANG S Y, YANG K Q, HUANG X Q, et al. Efficacy and safety of endoscopic ligation in secondary prevention of gastric variceal bleeding in cirrhosis patients [J]. Chin J Clin Med, 2024, 31(3): 367-373. DOI: 10.12025/j.issn.1008-6358.2024.20240635
Citation: JIANG S Y, YANG K Q, HUANG X Q, et al. Efficacy and safety of endoscopic ligation in secondary prevention of gastric variceal bleeding in cirrhosis patients [J]. Chin J Clin Med, 2024, 31(3): 367-373. DOI: 10.12025/j.issn.1008-6358.2024.20240635
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内镜下套扎用于肝硬化胃静脉曲张出血二级预防的效果及安全性

Efficacy and safety of endoscopic ligation in secondary prevention of gastric variceal bleeding in cirrhosis patients

    摘要
  • 摘要:
    目的 比较内镜下套扎治疗与内镜下组织胶注射用于肝硬化胃静脉曲张出血二级预防的疗效及安全性。
    方法 选择2017年1月至2019年12月因肝硬化胃静脉曲张出血入住复旦大学附属中山医院，行食管胃曲张静脉内镜下套扎治疗的患者（套扎组），另选择同期行内镜下组织胶注射治疗的患者（组织胶组），通过倾向性评分匹配，两组分别纳入59例。采用单因素与多因素Cox比例风险回归模型分析食管胃静脉曲张再出血影响因素。绘制Kaplan-Meier曲线，比较两组患者再出血及生存情况。
    结果 套扎组与组织胶组患者食管胃静脉曲张根除率差异无统计学意义（83.05% vs 79.66%，P＝0.778）；套扎组根除静脉曲张所须中位内镜治疗次数（2 vs 3次，P＝0.017）及平均组织胶用量明显少于组织胶组（0.70 mL vs 2.67 mL，P＜0.001）。多因素Cox回归分析显示，门体分流是食管胃静脉曲张再出血的危险因素（HR＝3.14，95%CI 1.02~9.68，P＝0.046），内镜下套扎是预防再出血的保护因素（HR＝0.25，95%CI 0.08~0.71，P＝0.010）。相较于内镜下组织胶注射，内镜下套扎不增加患者2年食管胃静脉曲张再出血风险（18.69% vs 36.29%，P＝0.067）与死亡风险（1.69% vs 3.39%，P＝1.000）。相较于内镜下组织胶注射，经内镜下套扎治疗后，GOV1型患者食管胃静脉曲张再出血风险较低（0 vs 40.27%，P＝0.012），GOV2型患者再出血风险（13.27% vs 34.16%，P＝0.056）呈降低趋势。
    结论 内镜下套扎治疗对食管胃静脉曲张的根除率较高，且并不增加再出血、死亡等事件风险，可作为胃静脉曲张出血患者的二级预防手段。

     

    Abstract:
    Objective To compare the efficacy and safety of endoscopic ligation treatment and endoscopic tissue glue injection for secondary prevention of gastric variceal bleeding.
    Methods Patients with cirrhosis and esophagogastric variceal bleeding treated with gastric variceal ligation in Zhongshan Hospital, Fudan University, from January 2017 to December 2019 were screened (ligation group). And during the same period, patients underwent endoscopic cyanoacrylate treatment were also screened (tissue glue group). 59 patients were included in the two groups after propensity score matching. Univariate and multivariate Cox proportional hazard regression models were used to anslyze risk factors for re-bleeding. Kaplan-Meier curves were plotted to analyze re-bleeding rate and mortality of the two treatment groups.
    Results There was no statistically significant difference in the eradication rate of esophagogastric varices between the ligation group and the tissue glue group (83.05% vs 79.66%, P＝0.778);the ligation group required fewer median endoscopic treatments for variceal eradication (2 vs 3, P＝0.017) and a lower average dosage of cyanoacrylate (0.70 mL vs 2.67 mL, P < 0.001). Multivariate Cox regression analysis showed that portal shunt was a risk factor for esophagogastric varices re-bleeding (HR＝3.14, 95%CI 1.02-9.68, P＝0.046), endoscopic variceal ligation was a protective factor against re-bleeding (HR＝0.25, 95%CI 0.08-0.71, P＝0.010). Compared with endoscopic cyanoacrylate injection, endoscopic ligation treatment did not significantly increase the 2-year risk of esophagogastric variceal re-bleeding (18.69% vs 36.29%, P＝0.067) or risk of death (1.69% vs 3.39%, P＝1.000); patients with GOV1 type had a significantly lower risk of re-bleeding after endoscopic ligation treatment (0 vs 40.27%, P＝0.012) and there was a trend towards a lower re-bleeding risk in patients with GOV2 type after endoscopic ligation treatment (13.27% vs 34.16%, P＝0.056).
    Conclusions Endoscopic ligation treatment has higher eradication rate for esophagogastric varices, and does not increase the risk of re-bleeding, death, or other adverse events. Therefore, it can be considered an effective secondary prevention way for patients with gastric varices.

     

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