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超声内镜引导下置入弹簧圈联合组织胶注射治疗合并自发性分流的胃静脉曲张的效果分析

汤雅芬 蒋智洋 龙丹 陈金敏 高山

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Citation:

超声内镜引导下置入弹簧圈联合组织胶注射治疗合并自发性分流的胃静脉曲张的效果分析

DOI: 10.12449/JCH240416
基金项目: 

湖北省卫生健康委科技项目 (WJ2021F066)

伦理学声明:本研究已于2019年2月28日取得襄阳市中心医院伦理委员会批准,批号:XYYZXYY-DLLL-PJ-2019-006。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:汤雅芬、蒋智洋负责调研,整理文献,设计论文框架,撰写论文;龙丹、陈金敏负责研究方案设计;高山负责终审论文。
详细信息
    通信作者:

    高山, 860792677@qq.com (ORCID: 0000-0002-8232-4234)

Efficacy of endoscopic ultrasound-guided coil placement combined with tissue adhesive injection in treatment of gastric varices with spontaneous shunt

Research funding: 

Science and Technology Project of Hubei Provincial Health Commission (WJ2021F066)

More Information
    Corresponding author: GAO Shan, 860792677@qq.com (ORCID: 0000-0002-8232-4234)
  • 摘要:   目的  评估超声内镜(EUS)引导下置入弹簧圈联合组织胶注射(ECI)治疗合并自发性分流的胃静脉曲张的有效性、安全性和经济性。  方法  回顾性分析2019年3月—2022年9月因急性胃静脉曲张出血合并自发性门体分流在襄阳市中心医院住院并接受改良球囊封堵逆行静脉闭塞术(BRTO)联合内镜下ECI或EUS引导下置入弹簧圈联合ECI治疗的患者。统计分析两种手术方式的疗效(技术成功率,5天、1年再出血率,再出血时间)、安全性(异位栓塞发生率、组织胶用量、聚桂醇用量)和经济性(住院费用和时间)差异。符合正态分布的计量资料两组间比较采用成组t检验,不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验。采用Kaplan-Meier法对再出血情况进行评估和比较。计数资料两组间比较采用χ2检验。  结果  25例患者在EUS引导下成功放置弹簧圈并注射组织胶,技术成功率100%,中位组织胶用量为2.5 mL,中位聚桂醇用量为11.0 mL,平均住院时间为(14.88±3.21)d,平均住院费用为(32 660.00±4 602.07)元,5天再出血率为0;2例失访,23例完整随访患者中住院期间异位栓塞发生率为0,中位再出血时间为689 d。14例患者接受改良BRTO联合内镜下ECI,技术成功率100%,术中中位组织胶用量为5.0 mL,高于EUS组(U=39.000,P<0.001),中位聚桂醇用量为10.5 mL;平均住院时间为(15.38±4.94)d;平均住院费用为(57 583.47±18 955.40)元,高于EUS组(t=-6.310,P<0.001);5天再出血率为0;无失访,14例完整随访患者中住院期间异位栓塞发生率为0,中位再出血时间为244.50 d。Kaplan-Meier生存曲线分析表明,2组患者再出血风险无明显差异(χ2=1.448,P=0.229)。  结论  EUS引导置入弹簧圈联合ECI是一种相对安全有效的胃静脉曲张出血治疗技术,技术成功率高,严重不良事件发生率低,疗效与BRTO手术无明显差异,但安全性和经济性更高。

     

  • 图  1  EUS组手术过程

    注: a,曲张静脉团块;b,EUS扇扫可见无回声区;c,超声动态监测可见血流信号;d,EUS引导下置入弹簧圈联合ECI治疗后可见血流信号消失。

    Figure  1.  Surgical procedure of EUS group

    图  2  术后影像学复查结果

    注: a,术后5天胃镜可见曲张静脉硬化;b,术后5天超声可见曲张静脉血流信号消失。

    Figure  2.  Postoperative images

    图  3  EUS组与BRTO组再出血时间分析

    Figure  3.  The Kaplan-Meier curve of the EUS group and BRTO group

    表  1  EUS组和BRTO组患者一般资料

    Table  1.   General information of patients with gastric varices and spontaneous portosystemic shunt

    项目 EUS组(n=25) BRTO组(n=14)
    男/女(例) 13/12 6/8
    年龄(岁) 60.88±8.42 57.64±10.82
    静脉曲张类型[例(%)]
    IGV1型 4(16.00) 11(78.57)
    GOV1型 2(8.00) 0(0.00)
    GOV2型 19(76.00) 3(21.43)
    分流类型[例(%)]
    胃肾分流 17(68.00) 10(71.43)
    脾肾分流 5(20.00) 2(14.29)
    胃肾+脾肾分流 3(12.00) 2(14.29)
    术前胃静脉曲张直径(cm) 1.44±0.39 1.48±0.34
    分流道最大直径(cm) 11.05±2.80 11.45±1.84
    分流道最小直径(cm) 6.17±1.47 6.57±1.34
    术前Child评分(分) 8.32±1.46 8.50±1.34
    术前MELD评分(分) 6.47±3.38 5.82±1.78
    注:IGV1,孤立性胃静脉曲张1型;GOV1,食管胃静脉曲张1型;GOV2,食管胃静脉曲张2型。
    下载: 导出CSV

    表  2  EUS组与BRTO组治疗有效性、安全性及经济性分析

    Table  2.   Effectiveness, safety and economic analysis between theEUS group and theBRTO group

    项目 EUS组(n=25) BRTO组(n=14) 统计值 P
    有效性指标[例(%)]
    技术成功率 25(100.00) 14(100.00) χ2=0.000 >0.05
    5天再出血率 0(0.00) 0(0.00) χ2=0.000 >0.05
    1年再出血率 4(17.39) 5(35.71) χ2=6.466 0.011
    安全性指标(mL)
    组织胶用量 2.5(1.5~3.5) 5.0(3.4~6.8) U=39.000 <0.001
    聚桂醇用量 11.0(7.0~14.0) 10.5(6.8~20.0) U=151.000 0.496
    经济性指标
    住院时间(d) 14.88±3.21 15.38±4.94 t=-0.33 0.743
    住院费用(元) 32 660.00±4 602.07 57 583.47±18 955.40 t=-6.31 <0.001
    注:BRTO组住院时间存在1个异常值,追溯原因后选择剔除。
    下载: 导出CSV
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  • 收稿日期:  2023-06-28
  • 录用日期:  2023-08-04
  • 出版日期:  2024-04-11
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