套扎与硬化治疗食管静脉曲张出血的临床对比研究  

Comparative Clinical Study of Ligation Versus Sclerotherapy in the Treatment of Bleeding Esophageal Varices

作　　者：刘德良[1] 霍继荣[1] 吴小平[1] 凌奇荷[1] 徐杨[1] 姚玉[1] 

机构地区：[1]湖南医科大学附属第二医院

出　　处：《湖南医学》1999年第2期90-92,共3页Hunan Medical Journal

摘　　要：【目的】比较应用内镜治疗肝硬化食管静脉曲张出血不同方法的疗效。【方法】对８１例肝硬化食管静脉曲张出血的病人随机采用套扎治疗（ＥＶＬ）或硬化治疗（ＥＶＳ），治疗后每３个月及再出血时接受内镜检查。【结果】ＥＶＳ组平均随访期（４１４±３８）ｄ，ＥＶＬ组（３９８±３５）ｄ。两组静脉曲张消除率相似（ＥＶＳ组９２５％，ＥＶＬ组９２７％，Ｐ＞０．０５）；ＥＶＬ组达到完全消除所需的平均治疗次数较少（２．７±０．３比３．６±０．１，Ｐ＜００５），但所需时间较长（３８±２．５比２２±２．０，Ｐ＜０．０１）；ＥＶＳ组的并发症率明显高于ＥＶＬ组（２０．０％比０％，Ｐ＜００５），但ＥＶＬ组静脉曲张复发率较高（３６６％比１２．５％，Ｐ＜０．０５）；两组的再出血率及死亡率比较差异无显著性（２０．０％比１７１％；２７．５％比２１．９％，均Ｐ＞０．０５）。【结论】两种方法疗效相似，ＥＶＬ在短期随访中优点突出，而随时间延长，静脉曲张复发率较高，所有患者第１年随访期均需接受频繁的内镜检查。Objective To compare the different efficiency of endoscopic treatment for bleeding esophageal varices in liver cirrhosis. Methods Eighty-one patients of liver cirrhosis with bleeding esophageal varices were randomly assigned to either esophageal varice ligation (EVL) or EV sclerotherapy(EVS).After eradication of the varices,patients received endoscopic examinations every three months and also recieved those for each episode of rebleeding. Results The mean follow-up periods were 414±38 days in the EVS group and 398±35 days in the EVL group;The two techniques were equally effective in eradicating varices(92.7% in EVL group and 92.5% in EVS group. P >0 05).The mean time of treatment to obtain eradication was lower in the EVL group(2 7±0.3 vs 3.6±0.1, P <0 05),while the duration required for eradication was rather longer (38±2.3 d vs 22±2.0 d, P <0.01).The rate of complications was significantly higher in the EVS than in the EVL group (20.0% vs 0%, P <0.05),while the rate of varices recurrence during follow-up was higher in the EVL group (36.6% vs 12.5%, P <0.05).The comparison of the rebleeding rate and death rate did not show any statistically significant differences between the two groups (20.% vs 17 1%;27.5% vs 21.9%, P >0.05). Conclusions While the two techniques are equally effective,EVL shows greater advantages in the short-term follow-up,but it is associated with more frequent recurrence of varices in the long term observation.All patients should have frequent endoscopic examinations throughout the first year of follow-up.

关 键 词：食管和胃静脉曲张 出血 止血.内窥镜 硬化疗法 

分 类 号：R571.305[医药卫生—消化系统]