食管曲张静脉套扎和硬化治疗疗效与安全性的前瞻性评估  

Efficacy and safety of endoscopic variceal ligation and endoscopic injection sclerotherapy in patients with cirrhosis and esophageal varices:a prospective study

作　　者：李盼[1] 孔德润[1] 谢惠君[2] 孙斌[1] 许建明[1] 

机构地区：[1]安徽医科大学第一附属医院消化科,安徽省合肥市230022 [2]安徽医科大学第一附属医院内镜室,安徽省合肥市230022

出　　处：《世界华人消化杂志》2010年第35期3791-3795,共5页World Chinese Journal of Digestology

基　　金：安徽省教育厅自然科学重点研究基金资助项目;No.KJ2010A158;安徽省卫生厅医学科研课题基金资助项目;No.2010B018~~

摘　　要：目的:探讨前瞻性研究内镜套扎疗法(endoscopic variceal ligation,EVL)和内镜硬化疗法(endoscopic injection sclerotherapy,EIS)治疗食管静脉曲张的疗效和安全性.方法:63例肝硬化食管静脉曲张患者,分为EIS组(n=36),EVL组(n=27).内镜治疗后随访6mo,并将死亡或6mo的疾病转归作为临床研究终点.比较两组的止血成功率、早期再出血率、迟发性再出血率、病死率及并发症发生率.结果:EVL组止血成功率高于EIS组,但差异无统计学意义(P=0.137).EIS组早期再出血率,迟发性再出血率高于EVL组,差异有统计学意义(44.4%vs12%,P=0.007;52.8%vs16%,P=0.004).EIS组病死率高于EVL组,但差异无显著性(19.4%vs4%,P=0.125).EIS组发热患者(63.9%vs25.9%,P=0.003)、平均发热天数(P=0.004)、胸痛患者(69.4%vs40.7%,P=0.023)、平均胸痛天数(P=0.006)、食管溃疡出血(19.4%vs0.0%,P=0.017)、腹胀(47.2%vs14.8%,P=0.007)的发生率明显高于EVL组,差异有显著性.结论:EVL治疗食管静脉曲张出血的疗效和安全性优于EIS,但仍需更多样本的严格对照研究.AIM：To prospectively determine the efficacy and safety of endoscopic variceal ligation （EVL） and endoscopic injection sclerotherapy （EIS） in patients with esophageal varices. METHODS：Sixty-three patients with liver cirrhosis and esophageal varices were divided into two groups：EIS group （n = 36） and EVL group （n = 27）. To compare the rates of hemostatic success,early rebleeding,delayed rebleeding,mortality,and other complications between the two groups,a 6-month prospective follow-up study was performed in patients after endoscopic therapy. RESULTS：The patients treated by EVL had a higher rate of hemostatic success than those by EIS though the difference was not significant （P = 0.137）. The EVL group had signicantly lower rates of early rebleeding （44.4% vs 12%,P = 0.007）,delayed rebleeding （52.8% vs 16%,P = 0.004）,and better survival （19.4% vs 4%,P = 0.125） than the EIS group. Furthermore,the patients treated by EVL also had a lower probability of fever （63.9% vs 25.9%,P = 0.003）,retrosternal pain （69.4% vs 40.7%,P = 0.023）,bleeding esophageal ulcer （19.4% vs 0%,P = 0.017）,and abdominal distention （47.2% vs 14.8%,P = 0.007） than those by EIS. CONCLUSION：EVL is more effective and safer than EIS in the treatment of esophageal varices because the former is associated with a lower probability of rebleeding and other complications.

关 键 词：肝硬化 食管静脉曲张 内镜硬化疗法 内镜曲张静脉套扎术 

分 类 号：R575.2[医药卫生—消化系统]