内镜下套扎术联合硬化剂注射术序贯治疗肝硬化合并食管静脉曲张的随机对照研究  

Therapeutic effect of endoscopic variceal ligation plus sclerotherapy for esophageal varices with liver cirrhosis： a randomized controlled trial

作　　者：刘荣[1] 黄爱霞[1] 朱珊玲 邵红征 杨润芝[1] 贺降福[1] 滕小军 

机构地区：[1]湖北省黄石市第五医院消化科,湖北省黄石市消化病防治研究所,435005 [2]黄石市中心医院消化内科

出　　处：《中华消化内镜杂志》2018年第2期94-98,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨肝硬化食管静脉曲张破裂出血内镜下套扎术（EVL）＋内镜下硬化剂注射术（EVS）序贯（EVLS）治疗的临床效果。方法肝硬化食管静脉曲张破裂出血患者52例，按计算机产生随机数字的方法分成EVL组24例和EVLS组28例，待活动性出血停止、病情稳定后行内镜超声（EUS）检查和首次EVL治疗，2周后EVL组和EVLS组分别行EVL和EVS继续治疗，每次治疗间隔时间为2周，直至曲张静脉消失。随访18个月，复查胃镜及EUS，观察食管曲张静脉和交通静脉的变化情况，并记录再出血和复发情况。结果与EVL组相比，EVLS组曲张静脉完全消失率差异无统计学意义[67．9％（19／28）比62．5％（15／24），P〉0．05]，达到曲张静脉完全及基本消失的平均治疗次数明显增多[（2．68±1．0）次比（1．83±0．7）次，P〈0．05]，治疗后穿通支闭塞率明显增加[70．8％（17／24）比23．8％（5／21），P〈0．05]。随访18个月，EVLS组和EVL组再出血率分别为3．6％（1／28）和12．5％（3／24），2组间差异无统计学意义（P〉0．05）。EVLS组和EVL组食管静脉曲张复发率分别为44．0％（11／25）和77．3％（17／22），差异有统计学意义（P〈0．05）。EVLS组和EVL组肝功能Child—PughB级患者的食管静脉曲张复发率分别为31．5％（5／16）和75．0％（9／12），差异有统计学意义（P〈0．05）。2组治疗后穿通支未闭塞者，均出现食管静脉曲张复发，而穿通支闭合者仅少部分复发。结论肝硬化食管静脉曲张行EVLS治疗疗效满意、复发率低，尤其是肝功能Child—PughB级者。食管壁穿通支可能在食管静脉曲张的形成及治疗后复发中起重要作用，治疗前后行EUS检查对食管静脉曲张治疗方法的选择及预测复发有较好指导意义。Objective To investigate the safety and efficacy of endoscopic varices ligation （EVL） plus endoscopic varices sclerotherapy （EVS） for esophageal variees hemorrhage in patients with liver cirrhosis. Methods Fifty-two liver cirrhosis patients with esophageal varices bleeding were randomly divided into EVL group （ n = 24） and EVLS group （ n = 28 ） according to random numbers generated by computer after first EVL. The EVL group continued undergoing EVL, and the EVLS group was treated by EVS. The interval of treatment was 2 weeks till varices disappeared. All patients were followed up for 18 months with endoscopy and endoscopic ultrasonography （EUS）. The efficacy, changes of esophageal varices and perforating veins, varices recurrence and rebleeding were observed. Results There was no significant difference of complete cure rate between EVLS group and EVL group [ 67. 9% （ 19/28 ） VS 62. 5% （15/24）, P〉0. 05]. The mean session of treatment （2.68±1.0 VS 1.83±0. 7, P〈0.05）, and perforating veins obliteration rate after treatment in EVLS group was higher than that in EVL group [ 70. 8% （17/24） VS 23.8% （5/21） , P〈0. 05 ]. During 18 months of follow-up, there was no significant difference of rebleeding rate between the two groups[3.6% （1/28） VS 12. 5% （3/24）, P〉0. 05], and the varices recurrence rate was higher in EVL group than that in EVLS group [ 77.3% （ 17/22 ） VS 44. 0% （ 11/25 ）, P 〈 0. 05 1. Child-Pugh class B patients in EVL group had a higher varices recurrence rate compared to that in EVLS group[75.0% （9/12） VS 31.5% （5/16） , P〈0. 05]. Endoscopic recurrences occurred in patients with non-occlusive perforating veins. Conclusion EVL plus EVS sequential procedure is safe and effective for treatment of esophageal varices hemorrhage, especially for Child-Pugh class B patients. Perforating veins may play a key role in the development of esophageal varices and recurrence after endoscopic therapy. EUS findings can direct the endoscopic therapy a

关 键 词：食管静脉曲张 食管静脉曲张内镜结扎术 食管静脉曲张硬化治疗术 内镜超声检查 

分 类 号：R575.2[医药卫生—消化系统]