内镜下聚桂醇硬化治疗重度食管静脉曲张破裂出血的效果观察  

Efficacy of endoscopic sclerotherapy with lauromacrogol in treatment of severe esophageal variceal bleeding

作　　者：崔美兰[1] 贾彦生[1] 康海燕[1] 殷树英[1] 郑欢伟[1] 

机构地区：[1]石家庄市第五医院肝病消化科,石家庄050021

出　　处：《临床肝胆病杂志》2017年第12期2321-2325,共5页Journal of Clinical Hepatology

基　　金：河北省卫生厅2016年医学科学研究重点课题计划(20160783)

摘　　要：目的观察内镜下聚桂醇硬化治疗肝硬化重度食管静脉曲张破裂出血的近、远期疗效。方法回顾性分析石家庄市第五医院2011年1月-2014年12月期间因肝硬化门静脉高压重度食管静脉曲张破裂出血首次行内镜下聚桂醇硬化治疗的患者160例,分为急诊治疗组(n=66)和择期治疗组(n=94),对患者随访观察了1~5年,统计患者的止血成功率、近期再出血率、远期再出血率、并发症发生率等。计数资料2组间比较采用χ2检验或Fisher确切概率法,计量资料2组间比较采用t检验。结果急诊治疗组与择期治疗组止血成功率(98.48%vs 100.00%)、静脉曲张根除或基本消失率(74.24%vs 82.98%)、静脉曲张根除或基本消失时间[(21.4±0.3)d vs(20.5±0.3)d]、静脉曲张复发率(18.18%vs 15.96%)、静脉曲张复发时间[(17.0±1.8)月vs(19.2±2.3)月]、远期再出血率(33.33%vs 21.28%)及并发症发生率(22.73%vs 18.09%)比较,差异均无统计学意义(P值均>0.05),近期再出血率(9.09%vs 1.06%)差异有统计学意义(P=0.020)。随访期间,160例患者中共死亡8例(5.00%),其中急诊治疗组死亡5例(食管静脉曲张破裂出血1例、肝性脑病2例、多脏器功能衰竭1例、肝癌结节破裂出血1例),择期治疗组死亡3例(食管静脉曲张破裂出血1例、多脏器功能衰竭1例、肝癌结节破裂出血1例)。2组病死率比较,差异无统计学意义(P=0.276)。结论内镜下聚桂醇硬化治疗重度食管静脉曲张破裂出血安全,近、远期疗效肯定,但需注意急诊治疗后近期再出血的发生。Objective To investigate the short-and long-term efficacy of endoscopic sclerotherapy with lauromacrogol in the treatment of cirrhotic patients with severe esophageal variceal bleeding. Methods A retrospective analysis was performed for the clinical data of 160 patients who underwent endoscopic sclerotherapy with lauromacrogol for the first time due to severe esophageal variceal bleeding caused by cirrhotic portal hypertension in The Fifth Hospital of Shijiazhuang from January 2011 to December 2014. These patients were divided into emergency treatment group with 66 patients and selective treatment group with 94 patients. All patients were followed up for 1-5 years,and a statistical analysis was performed for the success rate of hemostasis,short-term rebleeding rate,long-term rebleeding rate,and incidence of complications. The chi-square test or the Fisher＇s exact test was used for comparison of categorical data between two groups,and the t-test was used for comparison of continuous data between two groups. Results There were no significant differences between the emergency treatment group and the selective treatment group in the success rate of hemostasis（ 98. 48% vs 100. 00%,P〉0.05）,rate of eradication or disappearance of varices（ 74. 24% vs 82. 98%,P〉0.05）,time to the eradication or disappearance of varices（ 21. 4 ± 0. 3 d vs 20. 5 ±0. 3 d,P〉0.05）,variceal recurrence rate（ 18. 18% vs 15. 96%,P〉0.05）,time to variceal recurrence（ 17. 0 ± 1. 8 months vs 19. 2 ±2. 3 months,P〉0.05）,long-term rebleeding rate（ 33. 33% vs 21. 28%,P〉0.05）,and incidence rate of complications（ 22. 73% vs18. 09%,P〉0.05）,while there was a significant difference in short-term rebleeding rate between the two groups（ 9. 09% vs 1. 06%,P = 0. 020）. Of all 160 patients,8（ 5. 00%） died during follow-up,including 5 patients in the emergency treatment group（ one each died of esophageal variceal bleeding,multiple organ failure,and rupture and bleeding of liver cancer nodules,and 2 died of hepa

关 键 词：食管和胃静脉曲张 聚桂醇 硬化疗法 治疗结果 

分 类 号：R575.2[医药卫生—消化系统]