肝硬化合并食管静脉曲张破裂出血二级预防不同序贯疗法治疗效果分析  

Analysis of the effect of different sequential therapy on the treatment of esophageal varices bleeding for secondary prophylaxis

作　　者：王芳[1] 陈明锴[1] 肖勇[1] 刘仕倩 曾西[1] 吴楠楠[1] 张静[1] 李歆[1] 

机构地区：[1]武汉大学人民医院消化内科消化内镜中心,湖北省消化疾病微创诊治医学临床研究中心,武汉430060

出　　处：《首都医科大学学报》2016年第5期602-606,共5页Journal of Capital Medical University

基　　金：湖北省卫生和计划生育委员会西医类一般项目(WJ2015MB091)

摘　　要：目的比较内镜下不同序贯治疗方法对肝硬化合并食管静脉曲张破裂出血(esophageal varices bleeding,EVB)二级预防的疗效。方法收集资料完整且明确诊断为肝硬化合并EVB(内镜下分级均为重度)且行内镜下治疗的62例患者,分为3组:套扎序贯套扎组22例,硬化剂序贯硬化剂组10例,套扎序贯硬化剂组30例。以上病例随访1年以上,若1年内出现大出血、死亡为终点并进行回顾性分析。详细记录所有病例相关合并症、5天治疗失败率、6周病死率、1年再出血率、平均住院时间以及费用等。结果 1)3组患者合并症例数比较,硬化剂序贯硬化剂组中食管狭窄及感染相对其他两组高,差异有统计学意义(P<0.05)。2)5天治疗失败率、6周病死率在3种序贯方式比较中差异无统计学意义(P>0.05),但在1年再出血率中,套扎序贯硬化剂组效果佳,未出现再出血情况。其他两组(套扎序贯套扎组、硬化剂序贯硬化剂组)再出血较高。3)3组不同序贯疗法间住院天数差异均有统计学意义(P<0.05)。套扎序贯套扎组与硬化剂序贯硬化剂组的术中费用差异有统计学意义(P<0.05)。3组比较,套扎序贯硬化剂组住院时间相对较短,费用较低。结论内镜下序贯治疗是治疗EVB的重要方法,套扎序贯硬化剂模式的5天治疗失败率和6周病死率,与另外两种序贯治疗模式相当,但1年再出血率低、医疗资源节约上具有更大的优势。Objective To investigate the effect of different sequential therapy on the treatment of esophageal varices bleeding （EVB） in patients with liver cirrhosis on secondary prophylaxis. Methods Data of 62 cases with a clear diagnosis of cirrhosis complicated with EVB （endoscopic grading was severe） and undergone endoscopic treatment were collected, and the patients were randomly divided into three groups ： ligation sequential for ligation group （22 cases）, sclerotherapy sequential for sclerotherapy group （ 10 cases）, ligation sequential for sclerosing agent group （30 cases）. Different pathologic distribution in three different treatments was not significantly different （P 〉 0. 05 ）. More than 1 years of follow-up, and death within less than 1 year, rebleeding after operation and loss to follow-up were the end points of the operation in the retrospective analysis. Detailed records were made for all cases with related complications, 5 days of treatment failure rate, 6 weeks mortality, the rate of rebleeding of 1 year, the average days of stay in hospital and the cost of hospitalization. Results （1） The comparison of number of cases with complications between ligation sequential for ligation group, sclerotherapy sequential for sclerotherapy and ligation sequential for sclerosing group demonstrated that the number of esophageal stenosis and infection in sclerotherapy sequential for sclerotherapy was more than that of the other two groups, with a significant difference （ P 〈 0. 05 ）. （2） There was no significant difference （P 〉 0. 05） among the three sequential ways in failure rate 5 days post-treatment and the mortality rate six weeks post-treatment. But the rate of rebleeding one year post-treatment, the effect of ligation sequential for sclerosing group was quite good, there was no rebleeding. While the the rebleeding rates were higher than the other two groups （ligation sequential for ligation group, sclerotherapy sequential for sclerotherapy group）. （3） As to the

关 键 词：肝硬化 食管静脉曲张 出血 序贯治疗 

分 类 号：R571.3[医药卫生—消化系统]