内镜序贯治疗食管静脉曲张出血的临床研究  

Clinical study on endoscopic therapy of esophageal variceal bleeding

作　　者：朱萱[1] 梅瑞平[1] 刘志坚[1] 李弼民[1] 徐萍[1] 喻国花[1] 

机构地区：[1]南昌大学第一附属医院消化科,江西南昌330006

出　　处：《中国内镜杂志》2006年第7期702-705,709,共5页China Journal of Endoscopy

摘　　要：目的观察内镜下套扎与硬化序贯治疗(EVLS)对肝硬化食管静脉曲张破裂出血(EVB)的疗效和安全性。方法104例肝硬化EVB患者分为3组:EVS组38例,采用曲张静脉血管内注射硬化剂;EVL组40例;EVLS组26例。定期随访,观察食管静脉曲张消失率、再出血率、复发率及并发症发生率。结果3组静脉曲张消失率相似(EVS组81.6%,EVL组85.7%,EVLS组92.3%,P>0.05);达到静脉曲张完全消失所需的平均治疗次数:EVL组(1.8±0.6)次,明显少于EVS组的(3.0±1.0)次和EVLS组的(2.9±1.0)次(P<0.05);EVLS组曲张静脉完全消失所需的平均套扎环数(7.3±3.0)环少于EVL组(11.0±3.0)环,P<0.05,平均硬化剂量(20.2±10.7)mL少于EVS组(52.9±25.6)mL,P<0.05;3组的再出血率差异无显著性;EVLS组的并发症为19.2%,明显低于EVS组的32.7%(P<0.05),与EVL组的15.1%相似(P>0.05);EVLS组复发率为11.5%,低于EVL组的35.0%(P<0.05)和EVS组的15.8%(P>0.05)。结论EVLS组复发率及并发症低于其他两组,特别对于重度食管静脉曲张的患者,操作时安全性明显增加,因而序贯治疗是治疗食管静脉曲张出血的理想选择。[ Objective] Compared with endoscopic variceal sclerotherapy （EVS） and endoscopic variceal ligation （EVL）, the safety and efficacy of endoscopic variceal ligation plus sclerotherapy（EVLS） for esophageal variceal bleeding（EVB） was assessed. [Methods] One hundred and four patients with esophageal variceal bleeding in liver cirrhosis were assigned into three groups： thirty-eight patients were treated by EVS, forty patients by EVL and twenty- six patients by EVLS. The rate of varlceal eradication, rebleeding varices recurrence, complication and death were observed during the regular follow-up. [Results] The variceal eradication rate was similar in the three groups （EVS： 81.6%, EVL：85.7%, EVLS：92.3%, P 〉0.05）. The mean session of treatment to obtain eradication in the EVL group was lower than others （EVL： 1.8±0.6, EVS： 3.0±1.0, EVLS： 2.9±1.0, P 〈0.05）. In the EVLS group, the mean band of ligation was lower than the EVL group （7.3±3.0 vs 11.0±3.0, P 〈0.05）, and the mean dosage of injection was lower than the EVS group （20.2±10.7 vs 52.9±25.6, P 〈0.05）. There was not statistically significant difference in comparison of the rebleeding rate and death rate among the three groups. The rate of complication in the EVLS group was significantly lower than the EVS group （19.2% vs 32.7%, P 〈0.05）, and similar with the EVL group （19.2% vs 15.1%, P 〉0.05）. The rate of varices recurrence in the EVLS group was the lowest among the three groups. [Conclusions] The rate of varices recurrence and complication in the EVLS group were lower than the other groups , and to the patients with severe esophageal variceal especially, its operation safety was significant higher. So the EVLS methed is the optimal methed for the treatment of EVB.

关 键 词：食管静脉曲张 硬化治疗 套扎治疗 序贯治疗 

分 类 号：R571.3[医药卫生—消化系统]