超声内镜指导食管静脉曲张续贯治疗的临床意义  

The clinical significance of endoscopic ultrasonography guiding esophageal varices sequential therapy

作　　者：秦晶[1] 邱智辉[1] 杨丹玲[1] 陈伟芳[1] 张美萍[1] 邓乐[1] 武红艳[1] 唐志群[1] 崔毅[2] 

机构地区：[1]深圳市第三人民医院消化内科,广东深圳518112 [2]中山大学附属第一医院内镜中心

出　　处：《胃肠病学和肝病学杂志》2015年第12期1429-1432,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：医院科研基金资助(201205)

摘　　要：目的 探讨超声内镜（endoscopic ultrasonography,EUS）指导食管静脉曲张（esophageal varices,EV）内镜治疗方式及预测复发的意义。方法 将急性EV出血患者随机分研究组（A组）41例,对照组（B组）40例,所有患者急诊（出血12~72 h）行食管静脉曲张套扎术（EVL）,每2周再次行EVL至不能再套扎为止,第1次与最后1次行EVL 14 d后均行EUS观察有无食管旁静脉、食管周围静脉、穿静脉等。A组41例中36例见穿静脉,EUS指导1~2次食管静脉曲张硬化治疗（EIS）。B组40例中35例见穿静脉,对穿静脉不予处置。随访两组,均每3个月复查胃镜,6个月复查EUS,为期1年。结果 A组EUS指导EIS 1~2次后,穿静脉闭塞31例,未完全闭塞5例;B组2~3次EVL结束后穿静脉闭塞6例,未完全闭塞29例,差异有显著统计学意义（χ2=12.52,P=0.0004）。随访1年,A组复发16例,F2级5例,F1级11例,EUS显示均有穿静脉再通,无再出血者;B组复发34例,F3级3例,F2级16例,F1级15例,EUS显示穿通支增粗,食管周围静脉、食管旁静脉再生,且有2例分别于5个月、11个月再出血,给予EIS治疗止血。两组比较,复发率及复发严重程度差异均有统计学意义（P〈0.05）。结论 EUS在EV出血治疗方法选择上有指导意义,对预测复发有一定的价值。Objective To investigate the directive function and the significance of predicting recurrence of endoscop- ic ultrasonography （EUS） in treatment of esophageal varices （ EV）. Methods Acute EV bleeding patients were ran- domly divided into two groups： group A （n =41 ） as observation group and group B （n =40） as control group. Patients in both groups who were emergency bleeding treated via esophageal varices ligation （EVL） （within 12 -72 hours） and then treated again every two weeks till could not be ligated any more. The presence of paraesophageal veins, peripheral veins of esophageal veins and perforating veins were observed 14 days after the first and the last time of EVL. Perforating veins were seen in 36 patients out of total 41 in group A. 1 -2 times hardening treatment of esophageal varices （EIS） directed by EUS were performed in those 36 patients till perforating veins completely occlusion. Perforating veins were seen in 35 patients out of total 40 in group B without no treatment. Patients in both groups were followed-up for one year and rechecked by gastroscope and EUS every 3 months and 6 months, respectively. Results There were 31 patients with perforating veins complete occlusion and 5 patients with incomplete occlusion in group A after 1 ~ 2 times EIS di- rected by EUS. There were 6 patients with perforating veins completely occlusion and 29 patients with incompletely oc- clusion in group B after 2 - 3 times EVL and there were significant differences between two groups （X2 = 12.52, P = 0. 0004）. With one year of follow-up, 16 patients included 5 F1 grade and 11 F2 grade in group A, 34 patients induded 3 F3 grade, 16 F2 grade and 15 F1 grade in group B; EUS showed that the perforating veins increased thickly and the regeneration of paraesophageal veins, peripheral veins of esophagusesophageal veins. In addition, 2 cases of patients were performed by EIS because of recurrent bleeding, one in the fifth month and another in the 11 th month. Conclusion EUS plays a significan

关 键 词：超声内镜 食管静脉曲张 穿静脉 序贯治疗 

分 类 号：R571[医药卫生—消化系统]