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中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (05) : 390 -395. doi: 10.3877/cma.j.issn.2095-2015.2024.05.002

论著

华南地区门静脉高压食管胃静脉曲张出血内镜治疗现状调研分析
梁艳娉1, 陈燕柔2, 梁运啸3, 白飞虎4, 吴斌1, 王省1,†()   
  1. 1. 510630　广州，中山大学附属第三医院消化内科；510630　广州，广东省消化内镜工程技术研究中心
    2. 510630　广州，中山大学附属第三医院消化内科；510080　广州，中山大学中山医学院
    3. 530021　南宁，广西壮族自治区人民医院消化内科
    4. 570216　海口，海南医学院第二附属医院消化内科
  • 收稿日期:2024-03-03 出版日期:2024-10-01
  • 通信作者: 王省
  • 基金资助:
    国家自然科学基金(82070574); 广东省自然科学基金团队项目(2018B030312009)

Investigation report on endoscopic management of esophagogastric variceal bleeding in portal hypertension in Southern China

Yanping Liang1, Yanrou Chen2, Yunxiao Liang3, Feihu Bai4, Bin Wu1, Xing Wang1,†()   

  1. 1. Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China; Guangdong Province Engineering and Technology Research Center of Digestive Endoscopy, Guangzhou 510630, China
    2. Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China; Zhongshan Medical School, Sun Yat-sen University, Guangzhou 510080, China
    3. Department of Gastroenterology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
    4. Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical University, Haikou 570216, China
  • Received:2024-03-03 Published:2024-10-01
  • Corresponding author: Xing Wang
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梁艳娉, 陈燕柔, 梁运啸, 白飞虎, 吴斌, 王省. 华南地区门静脉高压食管胃静脉曲张出血内镜治疗现状调研分析[J]. 中华消化病与影像杂志(电子版), 2024, 14(05): 390-395.

Yanping Liang, Yanrou Chen, Yunxiao Liang, Feihu Bai, Bin Wu, Xing Wang. Investigation report on endoscopic management of esophagogastric variceal bleeding in portal hypertension in Southern China[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(05): 390-395.

目的

全面了解我国华南地区门静脉高压食管胃静脉曲张出血（EGVB）内镜治疗的现状。

方法

本研究通过网络分发调查问卷的方式全面了解华南地区广东省、广西壮族自治区及海南省开展门静脉高压EGVB内镜治疗的基本情况，包括预防EGVB的内镜治疗方案、急性EGVB的处理、胃底及特殊类型静脉曲张的处理、肝硬化门静脉高压的基础治疗与内镜治疗的随访等。医院的治疗方案选择使用百分率表示，并使用卡方检验或Fisher精确检验对不同省份医院对于我国指南的依从性进行比较分析。

结果

华南地区共81家医院参与调研，调查显示内镜治疗的最主要适应证是控制急性EGVB（60.5%）。参与调研医院对于我国指南中EGVB一级预防的推荐意见（单纯非选择性β受体阻滞剂或单纯内镜治疗）和二级预防推荐意见（非选择性β受体阻滞剂联合内镜治疗）的依从性为均为55.6%，不同省份之间无明显差异（P=0.976和0.186）。92.6%的医院首选内镜治疗处理急性EGVB，82.7%的医院在出血后12～24 h的时间窗内完成急诊内镜治疗。对于各种类型的胃底静脉曲张和异位静脉曲张，以组织胶为基础的内镜治疗（包括组织胶联合硬化剂注射和单纯组织胶注射）均为最常采用的术式。81.5%的医院将非选择性β受体阻滞剂常规用于肝硬化门静脉高压的治疗，主要使用的药物为普萘洛尔（80.2%）和卡维地洛（19.8%）。

结论

本研究证实多种预防和治疗EGVB的内镜治疗技术已在我国华南地区广泛开展，各级医院在开展急诊胃镜进行急性EGVB止血方面均较为积极，但对EGVB的一级预防和二级预防的总体指南依从性仍不理想，未来需进一步提升EGVB治疗的指南依从性。

关键词: 门静脉高压, 食管胃静脉曲张出血, 内镜治疗, 套扎, 硬化剂, 组织胶, 问卷调查, 指南依从性
Objective

To investigate the current situation of the use of endoscopic therapies for esophagogastric variceal bleeding (EGVB) in portal hypertension in Southern China area.

Methods

We carried out an online questionnaire survey to investigate the use of endoscopic therapies for EGVB in Guangdong province, Guangxi Zhuang Autonomous Region and Hainan province in South China. Questions included endoscopic choices for preventing EGVB, management of acute EGVB, management of gastric varices and special types of varices, fundamental treatment of cirrhosis-derived portal hypertension, and the follow up of endoscopic therapies. Hospital treatment options were expressed as percentage. Comparisons of guideline adherence among hospitals of different regions were performed with Chi-square or Fisher's exact test when appropriate.

Results

A total of 81 hospitals participated the study. The survey showed that the leading indication of endoscopic therapies was treating acute EGVB (60.5%). For primary and secondary prophylaxis of EGVB, adherence to national guideline was 55.6%, and no significant differences of the adherence were observed among different provinces (P=0.976 and 0.186, respectively). As much as 92.6% hospitals preferred endoscopic therapies treating acute EGVB, and most of the hospitals carried out emergency endoscopies within 12-24 hours after the presentation of bleeding (82.7%). In the treatment of various types of gastric varices and ectopic varices, cyanoacrylate injection-based procedures (including cyanoacrylate injection combined with sclerotherapy and cyanoacrylate injection alone) were the most prevalent procedures. 81.5% hospitals routinely used non-selective β-blockers for cirrhosis-derived portal hypertension, and main drugs were propranolol (80.2%) and carvedilol (19.8%).

Conclusion

This survey showcases that various endoscopic procedures for EGVB treatment have been conducted in Southern China. Participating hospitals are active to perform emergency endoscopies for acute EGVB, however, they are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. It is necessary to improve guideline compliance for EGVB therapy in the future.

Key words: Portal hypertension, Gastroesophageal varices, Endoscopic therapy, Band ligation, Sclerotherapy, Tissue glue, Questionnaire survey, Guideline adherence
表1 参与调研医院对我国指南的依从性（%）
我国指南推荐意见[4] 广东省(n=47) 广西壮族自治区(n=22) 海南省(n=12) 华南地区(n=81) P值
急性出血治疗时机a(出血后12~24 h) 83.0 81.8 83.3 82.7 0.991
急性出血治疗首选(内镜治疗) 91.5 90.9 100.0 92.6 0.567
一级预防的治疗选择a(NSBB或内镜治疗) 55.3 54.5 58.3 55.6 0.976
二级预防的治疗选择a(NSBB+内镜治疗) 63.8 40.9 50.0 55.6 0.186
表2 不同省份间指南依从性差异的比较（%）
我国指南推荐意见 广西壮族自治区a
P值		 海南省a
P值
急性出血治疗时机(出血后12~24 h) 0.906 0.977
急性出血治疗首选(内镜治疗) 0.936 0.295
一级预防的治疗选择(NSBB或内镜治疗) 0.952 0.851
二级预防的治疗选择(NSBB+内镜治疗) 0.073 0.381
图1 参与调研医院对于胃底静脉曲张和特殊类型静脉曲张的处理注：a以止血夹为基础的内镜治疗术式，包括单纯止血夹，或止血夹＋其他内镜治疗术式；GOV1食管延伸至小弯侧的胃底静脉曲张；GOV2近贲门大弯侧的胃底静脉曲张；IGV1孤立性胃底静脉曲张；IGV2异位静脉曲张。
表3 参与调研医院使用非选择性β受体阻滞剂的情况（%）
非选择性β受体阻滞剂使用 广东省(n=47) 广西壮族自治区(n=22) 海南省(n=12) 华南地区(n=81) P值
常规使用 87.2 77.3 66.7 81.5 0.219
使用药物种类          
普萘洛尔 85.1 77.3 66.7 80.2 0.330
卡维地洛 21.3 18.2 16.7 19.8 0.916
传统适应证(出血一级预防和二级预防) 87.2 77.3 66.7 81.5 0.219
新适应证(出血外的首次失代偿和进一步失代偿) 31.9 9.1 16.7 23.5 0.095
表4 不同省份间非选择性β受体阻滞剂使用差异的比较（%）
非选择性β受体阻滞剂使用 广西壮族自治区a
P值		 海南省a
P值
常规使用 0.484 0.206
使用药物种类    
普萘洛尔 0.646 0.294
卡维地洛 1.000 1.000
传统适应证（出血一级预防和二级预防） 0.484 0.206
新适应证（出血外的首次失代偿和进一步失代偿） 0.040 0.494
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