研究精准内镜下组织胶治疗胃静脉曲张的临床价值。

回顾性分析2013年3月至2019年11月浙江中医药大学附属杭州市西溪医院内镜下组织胶治疗食管胃静脉曲张3型（GOV3）患者60例，根据内镜下选择治疗胃静脉曲张（GV）的不同，分为精准组和经典组各30例。采用χ²检验比较2组患者治疗后1、3、6个月再出血率、急性门静脉血栓形成、并发症（包括异位栓塞）和转归（包括TIPS/外科手术、死亡率）等方面的差异；采用t检验比较2组患者GV穿刺点数、组织胶用量和Child-pugh评分等方面的差异。

2组患者在年龄、性别、病因、Child-pugh评分、急性门静脉血栓形成、呕血/黑便病史、脾切除术、GV联合钛夹等方面比较，差异均无统计学意义（P＞0.05）。精准组6个月累积GV穿刺点数和组织胶应用支数显著多于经典组［（9.07±3.59）点vs（2.90±1.71）点，（9.27±4.27）支vs（3.90±1.95）支，P均＜0.01］。精准组治疗后1、3、6个月再出血率均低于经典组（0 vs 16.7%，3.3% vs 36.7%，10.0% vs 46.7%，P均＜0.05）。2组患者在治疗后Child-pugh评分、发热、急性门静脉血栓形成、异位栓塞、再出血而死亡或转TIPS/手术等方面均无统计学差异［（6.47±1.48）分vs（6.40±1.54）分，10% vs 10%，0 vs 0，0 vs 0，0 vs 6.7%，0 vs 6.7%，P均＞0.05）］。

精准治疗可以减少GV组织胶治疗的再出血率。精准治疗发热、急性门静脉血栓形成、异位栓塞等并发症少见，对肝硬化患者Child-pugh评分亦无影响。

To assess the clinical value of precise endoscopic tissue glue therapy in the treatment of gastric varices (GV).

Sixty patients with gastroesophageal varices type 3 treated by endoscopic tissue glue therapy at our hospital from March 2013 to November 2019 were retrospectively analyzed. According to the difference of endoscopic treatment for GV, the patients were divided into either a precision group or a classical group, with 30 cases in each group. The chi-square test was used to compare the differences in the rates of rebleeding, acute portal vein thrombosis, complications (including ectopic embolism), and outcomes (including TIPS/ surgery and mortality) at 1, 3, and 6 months after treatment between the two groups. The t-test was used to compare the differences in GV puncture number, tissue glue dosage, and Child-Pugh score between the two groups.

There was no significant difference between the two groups in age, gender, etiology, Child-Pugh score, acute portal vein thrombosis, history of hematemesis/black stool, splenectomy, or GV combined with titanium clips (P＞0.05). The cumulative number of GV punctures and tissue glue application count in the precision group at 6 months were significantly higher than those in the classical group (9.07±3.59 vs 2.90±1.71, 9.27±4.27 vs 3.90±1.95, P＜0.01). The rates of rebleeding at 1, 3, and 6 months after treatment in the precision group were significantly lower than those of the classic group (0 vs 16.7%, 3.3% vs 36.7%, 10.0% vs 46.7%, P＜0.05). There were no statistically significant differences between the two groups in terms of Child-Pugh score, fever, acute portal vein thrombosis, ectopic embolism, death due to rebleeding, or TIPS/ surgery after treatment (6.47±1.48 vs 6.40±1.54, 10% vs 10%, 0 vs 0, 0 vs 0, 0 vs 6.7%, 0 vs 6.7%, P＞0.05).

Precise GV tissue glue treatment can reduce the rate of rebleeding and the rate of complications such as fever, acute portal vein thrombosis, and ectopic embolism while having no effect on Child-Pugh score in patients with cirrhosis.