多环与单环橡皮圈套扎在肝硬化食管静脉曲张出血急诊内镜治疗中的疗效比较  

Comparison between efficacy of single band and multi-band ligation of esophageal varices under emergency endoscopy for the treatment of esophageal varices bleeding in cirrhosis patients

作　　者：程计林[1,2] 赵红[2] 陈丽萍[1] 吕蓓[3] 黄绍萍[1] 樊贞瑜[1] 须亚红[1] 陆翠丽[1] 胡海平[1] 吴云林[4] 

机构地区：[1]上海市(复旦大学附属)公共卫生临床中心消化科,上海201508 [2]温州医科大学附属第一医院消化科,浙江温州325000 [3]复旦大学附属中山医院肝癌研究所,上海200032 [4]上海交通大学医学院附属瑞金医院北院消化内科,上海201801

出　　处：《内科理论与实践》2015年第4期280-283,共4页Journal of Internal Medicine Concepts & Practice

基　　金：上海市科委"科技创新行动计划"医学领域科技支撑项目(项目编号:15411950500)

摘　　要：目的:观察多环与单环套扎在肝硬化食管静脉曲张(EV)出血急诊内镜治疗后临床疗效的异同。方法:75例急诊内镜诊断为EV或合并胃底静脉曲张上消化道出血患者随机采用多环或单环橡皮圈套扎治疗,分为多环套扎治疗组和单环套扎治疗组。多环套扎治疗组40例,根据EV程度给予单位点2环、3环或4环套扎治疗;单环套扎治疗组35例。合并胃底静脉曲张须先给予硬化剂聚桂醇+组织胶+硬化剂方法注射治疗。单环套扎治疗再出血患者改用多环套扎治疗。结果:多环套扎治疗组治疗后胃镜复查EV完全消失8例,基本消失26例,EV消失率85%;单环套扎治疗组治疗后胃镜复查EV完全消失5例,基本消失15例,EV消失率57%;2组比较存在显著性差异(P<0.05)。1年再出血率多环套扎治疗组为5%,明显低于单环套扎治疗组的23%(P<0.05)。改用多环套扎治疗的再出血患者曲张静脉明显消失。结论:多环套扎治疗EV效果优于单环套扎治疗。Objective Observe the difference in efficacy of emergency endoscopic esophageal variceal ligation （EVL） with single-band or multi-band for the treatment of esophageal variceal bleeding in cirrhosis patients. Methods Seventy- five patients with diagnosis of esophageal varices （EV） and （or） gastric varices bleeding were treated with emergency gastroseopy. The patients were randomly divided into single-band and multi-band ligation groups. In multi-band ligation group （40 cases）, the varices were ligated with two, three, or four bands according to the severity of EV. For patients in single-band ligation group （35 cases）, those accompanied with gastric varices were treating the gastric fundic varices first with sandwich method （injection with hardener plus tissue adhesive then hardener again） and then ligated the EV. The patient with rebleeding after single-band were treated with multi-band. Results In multi-band ligation group, 8 and 26 cases had their EV completely eradicated and mostly eradicated, respectively. The disappearance rate of varices was 85%. The patients had their EV completely eradicated or mostly eradicated in single band ligation group were 5 cases and 15 cases, respectively. The disappearance rate of varices was 57%, significantly lower than that in multi-band group （P〈0.01）. During 1 year follow-up, the recurrence rate of EV in multi-band ligation group was 5%, significantly lower than that in single band ligation group （23%, P〈0.05）. After treating with multi-band, the patient with rebleeding had his EV eradicated. Conclusions Multi-band ligation had higher EV eradication rate as well as longer retention of sclerosant in varices. Multi-band ligation is superior to single-band ligation.

关 键 词：肝硬化 食管静脉曲张 套扎治疗 

分 类 号：R575.2[医药卫生—消化系统]