超声内镜引导下硬化剂注射对食管静脉曲张套扎术后残留曲张静脉及穿通支序贯治疗的观察  

Efficacy of EUS-guided sclerotherapy on residual esophageal varices and perforating vein after esophageal varices ligation

作　　者：尚瑞莲[1] 孙自勤[1] 贾爱芹[1] 李群[1] 魏志[1] 孙奎林[1] 刘晓峰[1] 

机构地区：[1]济南军区总医院全军肝硬化诊疗中心,济南250031

出　　处：《解放军医学杂志》2014年第7期572-575,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨超声内镜引导下硬化剂注射对食管静脉曲张套扎术后序贯治疗的疗效和安全性。方法 91例重度食管静脉曲张套扎术后患者按序贯治疗方式分为2组:超声组(n=42,接受超声内镜引导下食管下段残留曲张静脉及穿通支硬化剂注射)及胃镜组(n=49,接受胃镜下对残留曲张静脉硬化剂注射治疗)。至未再发现可治疗血管后进行随访。记录两组硬化剂注射剂量及次数、随访中曲张静脉复发及穿通支情况、并发症及再出血等情况。结果超声组注射硬化剂的次数低于胃镜组,但注射剂量高于胃镜组(P<0.05),超声组食管曲张静脉复发及穿通支出现率分别为7.1%、21.4%,明显低于胃镜组(分别为24.5%、42.9%),两组间差异有统计学意义(P<0.05);两组间并发症发生率分别为42.9%和26.5%,差异无统计学意义(P>0.05)。结论超声内镜可清晰显示套扎术后食管下段残留曲张静脉及穿通支,套扎术后序贯实施超声内镜引导下硬化剂注射操作安全,对减少曲张静脉复发及穿通支更具优势。Objective To evaluate the efficacy and safety of EUS-guided sclerotherapy on sequential therapy after esophageal varices ligation （EVL）. Methods Ninety-one patients with severe esophageal varices （EV） were divided into EUS-group （n=42） and gastroscopy group （n=49） according to different method of sequential treatment after EVL. The patients in EUS-group received sclerosant directly into the residual EV and perforating vein until the target veins were completely thrombosed without sign of blood flow. The patients in gastroscopy group accepted sclerotherapy via gastroscopy. All patients were followed up after the above mentioned varicose veins were completely eradicated. During follow-up the incidence of EV recurrence and the presence of perforating vein were observed with endoscopy or EUS, complications, the total number and dosage of sderosant injection, and episodes of rebleeding were recorded. Results The mean number of injection was significantly lower, and dose of sclerosant were statistically higher in EUS-group than in gastroscope group （P〈 0.05）. EV recurrence and the presence of perforating vein were 7.1% and 21.4% respectively in EUS-group, and they were significantly lower than that in gastroscope group （24.5%, 42.9%, P〈0.05）. There was no significant difference in incidence of complication between the two groups （42.9% vs 26.5%, P〉0.05）. Conclusions Residual EV and perforating vein after EVL can be clearly revealed with EUS. EUS-guided sclerotherapy after EVL is safe and may be superior in improving the result of sclerotherapy of EV and perforating vein.

关 键 词：食管和胃静脉曲张 超声检查 内窥镜 

分 类 号：R571.3[医药卫生—消化系统]