内镜下组织胶注射治疗肝硬化脾切除联合断流术后再发食管胃静脉曲张的临床研究

A clinical study of endoscopic histoacryl injection for newly‑developed esophagogastric varices in cirrhotic patients undergoing splenectomy combined with pericardial devascularization

摘要:

目的 探讨肝硬化行脾切除联合贲门周围血管离断术后再发食管胃静脉曲张患者行内镜下组织胶注射治疗的疗效。方法 收集2015年1月—2020年1月于南京大学医学院附属金陵医院消化内科行内镜下组织胶注射治疗、符合入组标准的125例肝硬化伴食管胃静脉曲张患者资料进行回顾性分析，其中脾切除联合贲门周围血管离断术后再发食管胃静脉曲张组（简称脾切除组）45例，非脾切除组80例，对两组患者的内镜治疗情况、内镜治疗后静脉曲张改善情况、再出血及并发症情况进行比较分析。结果 125例患者均成功完成内镜下组织胶注射，组织胶中位使用量为4.5 mL。1年后静脉曲张的改善情况：脾切除组总有效率为80.0%（36/45），非脾切除组总有效率为57.5%（46/80），两组显效、有效、无效例数构成差异有统计学意义（分别为16、20、9例和20、26、34例，χ2=6.469，P=0.039）。脾切除组和非脾切除组分别有2例和14例患者出现再出血，两组再出血率差异有统计学意义（4.4%比17.5%，Log‑rank P=0.039）。两组在1年内均无患者死亡，也无异位栓塞等严重并发症出现。结论 肝硬化伴食管胃静脉曲张合并脾功能亢进的患者接受脾切除联合贲门周围血管离断术后，与未行脾切除术的患者相比，应用内镜下组织胶注射治疗再发食管胃静脉曲张的近期疗效更好，可显著改善静脉曲张程度并降低再出血率。

Abstract:

Objective To investigate the efficacy of endoscopic histoacryl injection in cirrhotic patients with newly-developed esophagogastric varices (EGV) who have previously undergone splenectomy combined with pericardial devascularization. Methods From January 2015 to January 2020, 125 cirrhotic patients with EGV treated with endoscopic histoacryl injection at the Department of Gastroenterology, Jinling Hospital, Medical School of Nanjing University, were included in the retrospective analysis. There were 45 patients in the group of splenectomy combined with pericardial devascularization (splenectomy group for short) and 80 patients in the non-splenectomy group. The efficacy of endoscopic treatment, postoperative variceal improvement, rebleeding rate, and complications were analyzed between the two groups. Results Endoscopic histoacryl injection was successfully completed in all 125 patients, and the median volume of histoacryl was 4.5 mL. The overall effective rate in splenectomy and non-splenectomy group was 80.0% (36/45) and 57.5% (46/80), respectively. The difference in the number of significantly effective, effective, and ineffective cases between the two groups was statistically significant (16, 20, 9 cases, and 20, 26, 34 cases, respectively, χ2=6.469, P=0.039). Two and 14 patients developed rebleeding in the splenectomy group and non-splenectomy group, respectively; and the difference in the rebleeding rate between the two groups was statistically significant (4.4% VS 17.5%, Log-rank P=0.039). No patient died within 1 year in either group, and no serious complications such as ectopic embolism occurred. Conclusion After splenectomy combined with pericardial devascularization in cirrhotic patients with EGV and hypersplenism, the application of histoacryl has better short-term efficacy and can significantly reduce the rebleeding rate compared with the non-splenectomy group.