硬化剂注射方法改良后对食管静脉曲张出血疗效及并发症的影响

发布时间：2018-11-22 15:01

【摘要】：目的：回顾性对比分析陕西省人民医院消化内科近20年来采用不同的硬化剂注射方法治疗食管静脉曲张出血（Esophagogastric varices bleeding,EGVB）的疗效、及并发症的发生率，探讨止血率更高、并发症的发生率更低的内镜下硬化剂注射方法，从而为临床在治疗EGVB时采用更安全、治疗效果更好的治疗方法提供理论依据。方法：将陕西省人民医院消化内科近20年因EGVB经硬化剂注射治疗的患者根据硬化剂注射方法不同,分为两组，对照组（传统硬化剂治疗组，静脉内+静脉旁注射）：1992~1998年陕西省人民医院消化内科经传统硬化剂注射方法治疗EGVB的病例258例次；改良组(静脉内注射)：2009~2012年陕西省人民医院消化内科经改良后的硬化剂注射方法治疗EGVB的病例268例次，对比分析两组硬化剂注射治疗EGVB的止血成功率、治疗后的总体并发症发生率。结果： 1、改良组（静脉内注射）治疗食管静脉曲张出血的止血率为98.5%，而对照组（静脉内+静脉旁注射）的止血率为97.6%，两组采用χ2检验进行统计学分析，P＞0.05无统计学差异。 2、改良组硬化剂注射治疗后并发症的发生率为17.2%，对照组硬化剂注射治疗后的并发症发生率为43.4%，改良组（静脉内注射）治疗后的并发症发生率较对照组（静脉内+静脉旁注射）降低，经χ2检验分析，两组差异具有统计学意义。结论：内镜下硬化剂注射法（Endoscopic injection sclerotherapy,EIS）治疗食管静脉曲张出血安全、有效、止血率高，但是传统的硬化剂注射方法（静脉内+静脉旁注射）治疗后并发症（如发热、食管溃疡）的发生率较高，陕西省人民医院消化内科经改进硬化剂注射方法后采用静脉内快速注射硬化剂，经改良后的EIS并没有降低硬化剂注射治疗EGVB的高止血率，并且在高止血率基础上降低了治疗后并发症（如发热、食管溃疡）的发生率，使EIS治疗EGVB的技术更成熟，，安全性更高，并发症发生率更低，更值得临床应用。
[Abstract]:Objective: to compare and analyze retrospectively the curative effect of different sclerosing agent injection for esophageal variceal hemorrhage (Esophagogastric varices bleeding,EGVB) and the incidence of complications in the Department of Gastroenterology of Shaanxi Provincial people's Hospital in recent 20 years, and to explore the higher hemostatic rate. The lower incidence of complications of endoscopic sclerosing agent injection method for the clinical treatment of EGVB is safer and better treatment methods to provide a theoretical basis. Methods: the patients treated with sclerosing agent for EGVB in recent 20 years in the Department of Digestive Medicine of Shaanxi Provincial people's Hospital were divided into two groups according to the different methods of sclerosing agent injection: the control group, the traditional sclerosing agent group, and the control group. Intravenously): from 1992 to 1998, 258 cases of EGVB were treated by traditional sclerosing agent injection in the Department of Digestive Medicine, Shaanxi Provincial people's Hospital; Improvement group (intravenous injection): 268 cases of EGVB were treated with modified sclerosing agent injection method in Department of Gastroenterology, Shaanxi Provincial people's Hospital from 2009 to 2012. The hemostatic success rate of two groups of sclerosing agent injection for EGVB was compared and analyzed. Overall incidence of complications after treatment. Results: 1. The hemostatic rate of the modified group (intravenously injected) for esophageal variceal bleeding was 98.5 and that of the control group was 97.60.The two groups were statistically analyzed by 蠂 2 test. P > 0.05 there was no statistical difference. 2. The incidence of complications after sclerosing agent injection was 17.2in the modified group and 43.4 in the control group. The incidence of complications in the modified group (intravenously injected) was lower than that in the control group. The difference was statistically significant by 蠂 2 test. Conclusion: endoscopic sclerosing agent injection (Endoscopic injection sclerotherapy,EIS) is safe, effective and effective in the treatment of esophageal variceal bleeding. However, the traditional injection of sclerosing agent (intravenously injection) is safe, effective and effective in the treatment of complications (such as fever). The incidence of esophageal ulcers) was high. After improving the injection method of sclerosing agent, the Department of Digestive Medicine of Shaanxi Provincial people's Hospital adopted fast intravenously injection of sclerosing agent, but the modified EIS did not reduce the high hemostatic rate of EGVB treated with sclerosing agent injection. On the basis of high hemostasis rate, the incidence of post-treatment complications (such as fever, esophageal ulcer) was reduced. The technique of EIS in treating EGVB was more mature, the safety was higher, and the incidence of complications was lower, which was more worthy of clinical application.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R571.3

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