食管胃静脉曲张内镜下根治联合β-受体拮抗剂序贯治疗的远期疗效观察  

Long-term efficacy of radical treatment under endoscope for esophageal and gastric varices combined with β-blocker

作　　者：李庆芝[1] Li Qingzhi.(Department of Gastroenterology, Heze Muninal Hospital of Shandong Province, Heze 274000, Shandong, Chin)

机构地区：[1]山东省菏泽市立医院消化内科,山东菏泽274000

出　　处：《实用检验医师杂志》2017年第1期37-40,共4页Chinese Journal of Clinical Pathologist

摘　　要：目的观察食管胃底静脉曲张内镜下根治性治疗联合β-受体拮抗剂心得安治疗肝硬化食管胃底静脉曲张出血的远期疗效。方法随访观察2011年7月至2014年7月在菏泽市立医院住院治疗的乙型肝炎(乙肝)肝硬化食管胃底静脉曲张患者204例,根据患者意愿及之后的随访资料将其分为3组:A组(内镜下根治治疗+心得安序贯治疗组)即根据食管胃底静脉曲张程度行内镜下治疗,直至曲张静脉消失或不能再行内镜下治疗,内镜治疗结束后开始序贯口服心得安行降低门脉压治疗;B组(内镜下根治治疗组)未服用心得安;C组(心得安治疗组)。所有患者均进行内镜随访,随访时间为3年,分别记录静脉曲张消除例数、近期出血、远期出血例数及发生并发症情况。结果 3种治疗方案中近期再出血率比较差异均无统计学意义(3.0%、4.6%、5.5%,均P>0.05)。根治性治疗的静脉曲张消除率A、B组均显著高于C组(90.9%、87.5%比33.3%,均P<0.05),而A组与B组比较差异无统计学意义(90.9%比87.5%,P>0.05)。在远期再出血率方面,内镜下食管胃底曲张根治治疗A、B组均显著低于C组(22.7%、35.0%比74.0%,均P<0.05),但A组远期再出血率最低。结论内镜下食管胃底静脉曲张根治性治疗联合序贯心得安疗法在对食管胃底静脉曲张的静脉曲张消除率及远期出血率方面都有一定的优势,可供临床参考。Objective To evaluate the long-term efficacy of radical treatment under endoscope combined with β-blocker （propranolol） for esophageal and gastric variceal bleeding in patients with cirrhosis. Methods From July 2011 to July 2014, a follow-up study was conducted among 204 B hepatitis patients with cirrhosis and esophageal and gastric varices who treated in Heze Municipal Hospital and were divided in to three groups （groups A, groups B, groups C） according to the willings of their families and the follow-up data. In group A （radical treatment ＋ propranolol, sequentially）, patients were treated under endoscope based on the level of esophageal and gastric varices till varicose veins were eliminated or endoscopic treatment was no longer applicable, then they were given propranolol orally to reduce portal vein pressure. In group B （radical treatment）, patients were given only radical treatment without propranolol. In group C, propranolol orally. All patients were followed up with endoscope for three years totally. Varicose vein elimination, short-term bleeding, long- term bleeding and complications were recorded, respectively . Results No significant difference in the rate of short-term bleeding was found among the three groups （3.0%, 4.6%, 5.5%）, while the rates of varicose vein elimination in both groups A and B were significantly higher than group C （90.9%, 87.5% vs. 33.3%, all P 〈 0.05）. There was no significant difference between group A and group B （90.9% vs. 87.5%, P 〉 0.05）. As to the rate of long-term bleeding, both group A and group B （22.7%, 35.0%） were significantly lower than group C （74.0%）, the lowest rate of long-term bleeding was observed in group A. Conclusions For clinical reference, radical treatment under endoscope combined with propranolol for esophageal varicose has advantages with respect to varicose vein elimination and long-term bleeding of esophageal and gastric varices.

关 键 词：食管胃底静脉曲张 内镜下治疗 β-受体拮抗剂 序贯治疗 

分 类 号：R571[医药卫生—消化系统] R575.2[医药卫生—内科学]