内镜干预及联合普萘洛尔预防食管静脉曲张破裂再出血的疗效  

Efficacy of endoscopic intervention alone versus endoscopic intervention plus propranolol in the prophylaxis of esophageal variceal rebleeding

作　　者：王进广[1] 孔德润[1] 

机构地区：[1]安徽医科大学第一附属医院消化内科,安徽省合肥市230022

出　　处：《世界华人消化杂志》2012年第30期2944-2950,共7页World Chinese Journal of Digestology

基　　金：安徽省高校省级自然科学研究基金资助项目;No.KJ2010A158;No.KJ2012Z189;安徽省卫生厅医学科研课题基金资助项目;No.2010B018~~

摘　　要：目的:对比评估内镜下套扎或硬化剂治疗与内镜治疗联合普萘洛尔对预防食管静脉曲张破裂再出血的疗效.方法:将69例肝硬化患者随机分为2组,即单纯内镜治疗组(套扎或硬化剂治疗)40例和联合治疗组(套扎或硬化剂治疗后服用普萘洛尔)29例.随访1年以上并评估治疗后再出血情况、死亡率及再出血相关死亡率,并根据日本门脉高压协会诊断标准评估两种治疗方法对内镜下食管曲张静脉外观特征的影响.结果:治疗前后2组患者肝功能、血常规、电解质无显著差异.单纯内镜治疗后食管曲张静脉的直径显著减小(治疗前vs治疗后,10.92±2.91vs8.45±2.26,P<0.05),联合治疗组曲张静脉直径虽减小但不具有统计学意义(治疗前vs治疗后,10.14±2.46vs8.95±2.21,P>0.05).治疗后联合治疗组曲张静脉近端距门齿距离明显下移(治疗前vs治疗后,22.79±2.83vs24.85±3.96,P<0.05),且曲张静脉表面红色征较治疗前明显减少(治疗前vs治疗后,100%vs76.19%,P<0.05).与单纯内镜治疗组相比,联合治疗组胃底静脉曲张(治疗前vs治疗后,10.34%vs28.10%,P<0.05)及门脉高压性胃病的发生率均高于治疗前(治疗前vs治疗后,10.34%vs42.86%,P<0.05).2组曲张静脉形态均主要由串珠状转变为蚯蚓状,且均具有统计学意义(P<0.05).2组间再出血率(单纯内镜治疗组vs联合治疗组,50.00%vs51.71%,P>0.05)无统计学差异,但联合治疗组患者死亡率显著低于单纯内镜治疗组(联合治疗组vs单纯内镜治疗组,7.41%vs27.50%,P<0.05),且2组患者主要的死因为上消化道再出血.结论:内镜治疗后联合普萘洛尔预防食管静脉曲张破裂再出血在一定程度上可以降低患者死亡风险、减少内镜下曲张静脉高危再出血因素.AIM： To compar e the efficacy of endoscopic variceal ligation （EVL） or endoscopic injection sclerotherapy （EIS） alone versus EVL or EIS plus propranolol in the prophylaxis of esophageal variceal rebleeding.METHODS： Sixty-nine cirrhotic patients were divided randomly into endoscopic intervention group （EIG, n = 40; EVL or EIS） and combina-tion intervention group （CIG, n = 29; EVL or EIS plus propranolol）. The mortality, mortality due to rebleeding, and rate of rebleeding were compared between the two groups. All patients were followed for more than one year. In ad- dition, changes in endoscopic characteristics of esophageal varices were evaluated according to the criterion of the Japan Society for Portal Hy- pertension.RESULTS： There were no significantly dif- ferences in liver function, routine blood pa- rameters, and serum electrolytes between the two groups. After intervention, the diameter of varices decreased significantly in the EIG group （10.92± 2.91 vs 8.45 ± 2.26, P 〈 0.05）, but showed no significance in the CIG group （10.14 ± 2.46 vs 8.95± 2.21, P 〉 0.05）. The distance from the proximal end of varices to the fore-tooth （22.79 ± 2.83 vs 24.85 ± 3.96, P 〈 0.05） and the rate of recurrence of red signs in varices （100% vs 76.19%, P 〈 0.05） decreased significantly after intervention in the CIG group. The morbidity of gastric varices and portal hypertensive gas- tropathy were both higher after intervention in the CIG group （10.34% vs 28.10%, P 〈 0.05; 10.34% vs 42.86%, P 〈 0.05）. The appearance of varices in both groups changed from rosary- like to earthworm-like pattern. The rate of re- bleeding between two groups displayed no sig- nificant difference （50.00% vs 51.71%, P 〉 0.05）. However, the mortality in the CIG group was significantly lower than that in the EIG group （27.50% vs 7.41%, P 〈 0.05）, and the main cause of death in both groups was upper gastrointestinal bleeding.CONCLUSION： Endoscopic intervention combined with propranolol

关 键 词：食管静脉曲张 套扎 硬化剂 普萘洛尔 再 出血 死亡率 内镜 

分 类 号：R575.2[医药卫生—消化系统]