食管静脉曲张破裂出血内镜下套扎、硬化剂注射及序贯联合治疗的对比研究  

Comparison of endoscopic variceal ligation,endoscopic variceal sclerotherapy and sequential therapy in treatment of esophageal varices bleeding

作　　者：蔡升[1] 周建波[1] 桑建忠[1] 宋奇峰[1] 黄戬[1] 施煜燕[1] 孙晓晖[1] 杨倩倩[1] 

机构地区：[1]余姚市人民医院消化内科,315400

出　　处：《浙江医学》2017年第7期555-558,共4页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2014ZHA008)

摘　　要：目的比较曲张静脉套扎术(EVL)、硬化剂注射(EVS)及套扎序贯硬化剂注射(EVLS)治疗食管静脉曲张破裂出血的临床疗效。方法回顾性研究208例诊断为肝硬化伴食管静脉曲张破裂出血的患者,分为EVL组68例、EVS组67例及EVLS组73例,术后随访1年,观察食管静脉曲张急诊止血率、近远期再出血率、复发率及其并发症发生率(包括严重吞咽困难、食管狭窄、食管溃疡出血、持续性胸骨后痛疼等)。结果 3组患者急诊止血率及近期再出血率比较差异均无统计学意义(均P>0.05)。食管静脉曲张远期再出血EVLS组4例(5.5%)、EVL组21例(30.9%)及EVS组12例(17.9%),远期再出血率EVLS组最低(P<0.05),而EVL组与EVS组比较差异无统计学意义(P>0.05);食管静脉曲张复发EVLS组14例(19.2%)、EVL组32例(47.1%)及EVS组22例(32.8%),EVLS组较EVL组低(P<0.01),而EVLS组与EVS组及EVL组与EVS组比较差异均无统计学意义(均P>0.05);发生并发症EVS组29例(43.3%),EVLS组19例(26.0%),EVL组18例(26.5%),EVS组并发症发生率最高(P<0.05),EVLS组与EVL组差异无统计学意义(P>0.05)。结论治疗EVB,EVLS与EVL或EVS相比更具优势,保证了较高的急诊止血率,有效降低复发率及远期再出血率,同时避免了较高的并发症发生率,值得临床进一步推广。Objective To evaluate the clinical efficacy of endoscopic variceal ligation（EVL）,endoscopic variceal sclerotherapy（EVS） and endoscopic sequential variceal ligation plus sclerotherapy（EVLS） in treatment esophageal varices bleeding（EVB）.Methods Total 208 cirrhotic patients with esophagealvarices bleeding were divided into EVL group（n=68）,EVS group（n=67） and EVLS group（n=73）.Patients were followed-up for 1 year,the emergency hemostatic rate,recent and long-term rebleeding rate,recurrence rate and the incidence rate of complications（including serious dysphagia,esophageal stenosis,esophagealulcer bleeding,continuous substernal pain） were compared among three groups.Results There was no significant difference in emergency hemostatic rate and recent rebleeding rate among three groups（P 〉0.05）.The long-term rebleeding occurred in 4 cases（5.5%） of EVLS group,21 cases（30.9%） of EVL group and 12 cases（17.9%） of EVS group（P〈0.05）,while there was no significant difference between EVL and EVS groups（P 〉0.05）.The recurrence of esophageal varices occurred in 14cases（19.2%） of EVLS group,32 cases（47.1%） of EVL group and 22 cases（32.8%） of EVS group,the recurrence rate of EVLS group was lower than that of EVL group（P〈 0.01）,while there was no significant difference between EVLS and EVS groups,EVL and EVS groups（P 〉 0.05）.The incidence rate of complications in EVS,EVLS and EVL groups were 43.3%,26.0%and 26.5%,respectively;the complication rate of EVS group was higher than that of other two groups（P〈 0.05）,while there was no significant difference between EVLS and EVLgroups（P 〉 0.05）.Conclusion The endoscopic sequential variceal ligation plus sclerotherapy can ensure emergency hemostasis,effectively reduce the recurrence and long-term rebleeding with low incidence of complications in treatment ofesophagealvarieces.

关 键 词：食管静脉曲张破裂出血 肝硬化 曲张静脉套扎术 硬化剂注射 套扎序贯硬化治疗 

分 类 号：R575.21[医药卫生—消化系统]