高渗葡萄糖或聚桂醇与组织粘合剂夹心法治疗食管胃底静脉曲张破裂出血成本-效果分析研究

doi:10.12114/j.issn.1007-9572.2019.00.330

摘要/Abstract

摘要： 背景　肝硬化是一种慢性弥漫性肝病，食管胃底静脉曲张破裂出血是最严重的并发症之一，内镜下套扎术和组织粘合剂注射是治疗食管胃底静脉曲张破裂出血的关键措施，为了更有效地注射组织粘合剂，临床上常采用高渗葡萄糖或聚桂醇与组织粘合剂夹心法。目的　比较高渗葡萄糖或聚桂醇与组织粘合剂夹心法治疗食管胃底静脉曲张破裂出血的成本-效果。方法　选取2013年7月—2017年7月南方医科大学附属萍乡医院收治的食管胃底静脉曲张破裂出血患者164例，采用随机数字表法将其分为高渗葡萄糖与组织粘合剂夹心法组（HGC组，70例）和聚桂醇与组织粘合剂夹心法组（LC组，94例）。其中HGC组采用高渗葡萄糖与组织粘合剂夹心法，LC组采用聚桂醇与组织粘合剂夹心法。比较两组止血率、再出血率、静脉曲张改善情况。进一步根据胃底静脉曲张根数和直径分为：根数×直径<2（根?cm）（其中HGC组36例，LC组49例）和根数×直径≥2（根?cm）（其中HGC组34例，LC组45例），比较两组成本及成本-效果比，并观察并发症和不良反应发生情况。结果　HGC组和LC组即时止血率均为100.0%。治疗后1周、1个月、2个月，两组止血率比较，差异均无统计学意义（P>0.05）。治疗后3个月、6个月、1年，两组再出血率比较，差异均无统计学意义（P>0.05）。治疗后1、3、6个月，两组静脉曲张改善情况比较，差异均无统计学意义（P>0.05）。对于根数×直径<2（根?cm）的胃底静脉曲张，两组注射次数、注射点数、组织粘合剂总量、住院成本、即时成本-效果比、1周止血率、1周成本-效果比、1个月止血率、1个月成本-效果比、2个月止血率和2个月成本-效果比比较，差异均无统计学意义（P>0.05）；对于根数×直径≥2（根?cm）的胃底静脉曲张，LC组注射次数、注射点数、组织粘合剂总量、住院成本、即时成本-效果比、1周成本-效果比、1个月成本-效果比和2个月成本-效果比均低于HGC组（P<0.05）。两组术后发热、胸腹部疼痛发生率比较，差异均无统计学意义（P>0.05）；LC组局部溃疡、异位栓塞发生率低于HGC组（P<0.05）。结论　高渗葡萄糖或聚桂醇与组织粘合剂夹心法均能有效治疗食管胃底静脉曲张破裂出血，且效果相近，从成本-效果考虑，对于根数×直径<2（根?cm）的胃底静脉曲张，两种方法成本相近，效果相近，均可选用；对于根数×直径≥2（根?cm）的胃底静脉曲张，两种方法效果相近，但聚桂醇与组织粘合剂夹心法的成本更低，不良反应反应更少，是更佳方案。

关键词: 食管和胃静脉曲张；出血；组织粘合剂；聚桂醇；葡萄糖溶液, 高渗；费用效益分析

Abstract: Background　Gastroesophageal variceal hemorrhage is a most serious complication of hepatic cirrhosis，a chronic and diffuse liver disease.Endoscopic ligation and cyanoacrylate injection are used as the key treatments.To achieve better effectiveness of cyanoacrylate injection，sandwich therapy of cyanoacrylate in combination with hypertonic glucose（hypertonic glucose-cyanoacrylate-hypertonic glucose，HCH） or lauromacrogol（lauromacrogol-cyanoacrylate-lauromacrogol，LCL） are often used.Objective　To perform a cost-effectiveness analysis of HCH versus LCL sandwich therapy in the treatment of gastroesophageal variceal hemorrhage.Methods　A total of 164 patients with gastroesophageal variceal hemorrhage were recruited from Southern Medical University Affiliated Pingxiang Hospital from July 2013 to July 2017 and were randominzed into HCH group（n=70） and LCL group（n=94），treated with HCH，LCL sandwich therapy，respectively.Improvement in hemostasis rate，rebleeding rate and varices between the groups were compared.According to the numbers and diameter，the gastric varices were assigned into 2 groups：number×diameter < 2 （ones ? cm） group （36 cases in HCH group and 49 cases in LCL group）；number×diameter ≥ 2 （ones ? cm） group （34 cases in HCH group and 45 cases in LCL group）．The cost and cost-effectiveness ratios of the 2 groups，treatment-related complications and adverse reactions were analyzed.Results　The immediate hemostasis ratios of both groups were 100.0%.There were no significant differences between the hemostasis ratios at 1 week，1 month，and 2 months after treatment between the 2 groups （P>0.05）．There were no significant differences between the rebleeding ratios at 3 months，6 months，and 1 year after treatment between the 2 groups （P>0.05）．There were no significant difference between the improvement ratios of the varicose veins at 1，3，and 6 months after treatment between the 2 groups （P>0.05）．For the treatment of gastric varices with diameter < 2（number×diameter，ones ? cm），there were no significances between the groups in terms of injection times，the injection points，the total amount of cyanoacrylate，cost，immediate cost-effectiveness ratio，1-week hemostasis rate，1-week cost-effectiveness ratio，1-month hemostasis rate，1-month cost-effectiveness ratio，2-month hemostasis ratio and 2-month cost-effectiveness ratio （P>0.05）；for treating gastric varices with diameter ≥ 2（number×diameter，ones ? cm），LCL group showed less injection times，injection points，total cyanoacrylate，cost，immediate cost-effectiveness ratio，1-week cost-effectiveness ratio，1-month cost-effectiveness ratio and 2-month cost-effectiveness ratio （P<0.05）．There were no significant differences between the incidence rates of postoperative fever，and chest and abdomen pain between the 2 groups （P>0.05）．The incidence rates of local ulcer and ectopic embolism in LCL group were lower than those of the HCH group （P<0.05）．Conclusion　Both therapies are efficient for gastroesophageal variceal hemorrhage，and can achieve similar effectiveness.Cost-effectiveness anlaysis of the treatment by number×diameter < 2 （ones ? cm） of gastric varices shows that both therapies have similar cost and effectiveness，and either of them can be selected.Further anlaysis of the treatment by the number×diameter ≥ 2 （ones ? cm） of gastric varices indicates that both of them have nearly equal effectiveness，but LCL sandwich therapy has lower cost and fewer adverse reactions，suggesting that LCL sandwich therapy is better.

Key words: Esophageal and gastric varices；Hemorrhage；Cyanoacrylate；Lauromacrogol；Glucose solution, hypertonic；Cost-benefit analysis

林秋满,王桂良,邱萍,等. 高渗葡萄糖或聚桂醇与组织粘合剂夹心法治疗食管胃底静脉曲张破裂出血成本-效果分析研究[J]. 中国全科医学, 2020, 23(8): 974-979. DOI: 10.12114/j.issn.1007-9572.2019.00.330.
LIN Qiuman,WANG Guiliang,QIU Ping, et al. Hypertonic Glucose Versus Lauromacrogol with Cyanoacrylate Sandwich Therapy for Gastroesophageal Variceal Hemorrhage：a Cost-effectiveness Analysis　[J]. Chinese General Practice, 2020, 23(8): 974-979. DOI: 10.12114/j.issn.1007-9572.2019.00.330.

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