超声内镜引导下食管外侧支静脉穿刺组织胶选择性封闭术治疗肝硬化伴食管静脉曲张的有效性（含视频）

Efficacy of endoscopic ultrasound-guided paraesophageal varices puncture cyanoacrylate selective seal for liver cirrhosis complicated with esophageal varices（with video）

摘要:

目的：探讨超声内镜引导下食管外侧支静脉穿刺组织胶选择性封闭术的疗效。方法：回顾性分析2023年1月至2023年10月于北京地坛医院就诊的肝硬化伴食管静脉曲张行超声内镜引导下食管外侧支静脉穿刺组织胶选择性封闭术（治疗组，n=40）或常规内镜下组织胶治疗（对照组，n=46）的86例患者资料。比较两组重度静脉曲张患者占比下降值、术中组织胶用量、穿刺静脉次数 及半年再出血率等。结果：两组患者在性别、年龄、血常规、肝肾功能、重度静脉曲张占比等基线资料差异无统计学意义（P＞0.05）。治疗组患者在治疗前重度静脉曲张占比90.0%（36/40），治疗后占比12.5%（5/40），重度静脉曲张的比例下降77.5%；对照组患者在治疗前重度静脉曲张占比89.1%（41/46），治疗后占比43.5%（20/46），重度静脉曲张的比例下降45.6%，治疗组比对照组患者静脉曲张重度的比例下降更多（χ2=13.86，P＜0.001）。治疗组应用组织胶的量明显更少（2.5 mL 比 3.0 mL，Z=-3.55，P＜0.001），穿刺静脉的次数明显更少（2次比6次，Z=-7.10，P＜0.001）。两组患者治疗后半年内再出血率差异无统计学意义[12.5%（5/40）比10.9%（5/46），χ2=0.06，P=0.814]。结论：肝硬化伴食管静脉曲张患者，行超声内镜引导下食管外侧支静脉穿刺组织胶选择性封闭术效果比常规内镜下治疗更好，应用组织胶量更少，值得推广应用。

Abstract:

Objective: To investigate the efficacy of endoscopic ultrasound-guided paraesophageal varices puncture cyanoacrylate selective seal. Method: Data of 86 patients with liver cirrhosis complicated with esophageal varices undergoing endoscopic ultrasound-guided paraesophageal varices puncture cyanoacrylate selective seal (the treatment group, n=40) and conventional endoscopic tissue glue injection treatment (the control group, n=46) were retrospectively collected from Beijing Ditan Hospital from January 2023 to October 2023. The reduced percentage of severe varicose veins, the amount of tissue glue during operation, the number of punctures and the rate of rebleeding in six months were compared. Results: There were no significant differences in the baseline data including gender, age, blood routine index, liver and kidney functions, proportion of severity varicose veins between the two groups（P＞0.05）. In the treatment group, severe varicose veins accounted for 90.0% (36/40) before treatment while it was 12.5% (5/40) after the treatment, and the proportion of severe varicose veins decreased by 77.5%. In the control group, the proportion of severe varicose veins was 89.1% (41/46) before while it was 43.5% (20/46) after the treatment, and the proportion of severe varicose veins decreased by 45.6%. The proportion of severe varicose veins decreased more in the treatment group than that in the control group (χ2=13.86, P＜0.001). Compared with the control group, the amount of tissue glue applied in the treatment group was significantly less (2.5 mL VS 3.0 mL, Z=-3.55, P＜0.001), and the number of punctures was also significantly less (2 VS 6, Z=-7.10, P＜0.001). There was no significant difference in the rate of rebleeding within six months after the treatment between the two groups [12.5% (5/40) VS 10.9% (5/46),χ2=0.06, P=0.814]. Conclusion: For patients with cirrhosis complicated with esophageal varices, endoscopic ultrasound-guided paraesophageal varices puncture cyanoacrylate selective seal demonstrated superior efficacy over conventional endoscopic treatment, with less tissue glue applied, which is worth of promotion and application in clinical practice.