三通联合三明治注射法在超声内镜引导下弹簧圈联合组织胶栓塞治疗胃底静脉曲张出血的临床应用研究

Application of three⁃way stopcock combined with endoscopic ultrasound⁃guided sandwich injection method of coil and tissue adhesive for gastric variceal bleeding

摘要:

为研究超声内镜引导下三通联合三明治注射法在弹簧圈栓塞治疗胃底静脉曲张出血中的应用效果，纳入在首都医科大学附属北京友谊医院2023年9月至11月因肝硬化门脉高压发生胃底静脉曲张破裂出血需超声内镜引导下行组织胶栓塞治疗的患者48例，按组织胶注射方案不同分为试验组（n=25，三通联合三明治组织胶注射法）和对照组（n=23，传统三明治组织胶注射法）。主要评价指标为组织胶注射堵针情况，次要指标为胃静脉曲张的改善程度、治疗时间、操作医师满意度和术后并发症发生情况。结果显示试验组（通畅/部分堵塞/完全堵塞：20/4/1）与对照组（通畅/部分堵塞/完全堵塞：10/8/5）堵针发生情况差异有统计学意义（P=0.032）。胃静脉曲张缓解情况试验组（显效/有效/无效：21/3/1） 明显优于对照组（显效/有效/无效：11/9/3），差异有统计学意义（P=0.026）；试验组治疗时间为（43.6±2.8）min，对照组为（63.0±3.5）min，试验组明显短于对照组（t=-20.997，P<0.001）；操作医师满意度治疗组为92.0% （23/25），对照组为65.2% （15/23），差异有统计学意义（P=0.033）。术后发生低热的患者试验组有4例（16.0%），对照组有11例（47.8%），差异有统计学意义（χ2=5.648，P=0.029）。在超声引导下采用优化组织胶注射法进行弹簧圈栓塞治疗胃底静脉曲张出血可以降低穿刺针注射堵塞率，提高手术成功率，节省治疗时间并提高医师满意度。

Abstract:

To study the efficacy of three-way stopcock combined with endoscopic ultrasound-guided sandwich injection method of coil and tissue adhesive for gastric variceal bleeding, 48 patients with gastric variceal bleeding due to cirrhotic portal hypertension who intended to receive endoscopic ultrasound-guided sandwich injection method in Beijing Friendship Hospital Capital Medical University from September to November 2023 were included and divided into the test group (n=25, treated with three-way stopcock combined with sandwich injection method) and the control group (n=23, treated with traditional sandwich injection method) according to different treatment methods in the study. The primary outcome was injection needle blockage rate of tissue adhesive and second outcomes were the degree of gastric varices improvement, treatment time, endoscopist satisfaction and postoperative complications. The results showed a significant difference (P=0.032) in the occurrence of injection needle blockage between the test group (unobstructed/partially obstructed/completely obstructed, 20/4/1) and the control group (unobstructed/partially obstructed/completely obstructed, 10/8/5). The degree of gastric varices improvement in test group (markedly effective/effective/ineffective, 21/3/1 ) was much better than that in the control group (markedly effective/effective/ineffective, 11/9/3) with significant difference (P=0.026). The treatment time in the test group (43.6±2.8 min) was much shorter than that in the control group (63.0±3.5 min, t=-20.997, P<0.001). The endoscopist satisfaction was 92.0% (23/25) in the test group and 65.2% (15/23) in the control group with significant difference (P=0.033). Postoperative low fever occurred in 4 (16.0%) patients in the test group and 11 (47.8%) in the control group with significant difference (χ2=5.648, P=0.029). Application of three-way stopcock combined with sandwich injection method of coil and tissue adhesive in endoscopic ultrasound-guided treatment for gastric variceal bleeding can reduce injection needle blockage rate, improve procedure success rate, shorten treatment time and increase endoscopist satisfaction.