内镜下密集套扎法治疗食管静脉曲张破裂出血的效果观察  

Clinical effect of endoscopic dense ligation in treatment of esophageal variceal bleeding

作　　者：崔美兰[1] 贾彦生[1] 闫会敏[1] 康海燕[1] 王艳[1] 殷树英[1] 郑欢伟[1] CUI Meilan;JIA Yansheng;YAN Huimin(Shijiazhuang Fifth Hospital,Shijiazhuang 050021,China)

机构地区：[1]河北省石家庄市第五医院,石家庄050021

出　　处：《临床肝胆病杂志》2018年第8期1683-1688,共6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：目的观察内镜下密集套扎法治疗食管静脉曲张破裂出血的临床疗效。方法选取石家庄市第五医院2015年7月-2016年6月因肝硬化门静脉高压食管静脉曲张破裂出血首次行内镜下套扎治疗的156例患者的临床资料,根据治疗方法不同分为密集套扎组(n=76)和非密集套扎组(n=80)。对患者随访观察1~2年,统计患者的静脉曲张根除或基本消失率、套扎次数、早期再出血率、迟发性再出血率及不良反应发生率等。计量资料2组间比较采用t检验;计数资料2组间比较采用χ~2检验或Fisher精确检验。结果密集套扎组与非密集套扎组静脉曲张根除或基本消失率(71.05%vs 55.00%)、套扎次数比较,差异均有统计学意义(χ~2值分别为4.300、8.511,P值分别为0.038、0.014),2组患者早期再出血率(5.26%vs 2.50%)、迟发性再出血率(7.89%vs10.00%)、静脉曲张复发率(13.16%vs 18.75%)及不良反应发生率(26.32%vs 21.25%)比较,差异均无统计学意义(P值均>0.05);静脉曲张复发时间比较,差异有统计学意义[(11.90±1.89)个月vs(7.07±1.17)个月,t=2.295,P=0.031]。随访期间,156例患者中共死亡2例(1.28%),其中密集套扎组和非密集套扎组各死亡1例。2组病死率比较,差异无统计学意义(P>0.05)。结论内镜下密集套扎法治疗食管静脉曲张破裂出血较安全,静脉曲张消失率及套扎次数优于非密集套扎法,静脉曲张复发晚。Objective To investigate the clinical effect of endoscopic dense ligation in the treatment of esophageal variceal bleeding. Methods A total of 156 patients who underwent endoscopic ligation for the first time due to esophageal variceal bleeding caused by cirrhotic portal hypertension in Shijiazhuang Fifth Hospital from July 2015 to June 2016 were enrolled,and according to the treatment method,they were divided into dense ligation group with 76 patients and non-dense ligation group with 80 patients. The patients were followed up for 1-2 years,and a statistical analysis was performed for the eradication or disappearance rate of varices,the number of times of ligation,early rebleeding rate,late-onset rebleeding rate,and the incidence rate of adverse reactions. The t-test was used for comparison of continuous data between two groups,and the chi-square test or Fisher＇s exact test was used for comparison of categorical data between two groups. Results There were significant differences between the dense ligation group and the non-dense ligation group in the eradication or disappearance rate of varices（ 71. 05% vs 55. 00%,χ~2= 4. 300,P = 0. 038） and number of times of ligation（ χ~2= 8. 511,P = 0. 014）,and there were no significant differences between the two groups in early rebleeding rate（ 5. 26% vs 2. 50%,P〉 0. 05）,late-onset rebleeding rate（ 7. 89% vs 10. 00%,P 〉0. 05）,recurrence rate of varices（ 13. 16% vs 18. 75%,P〉 0. 05）,and incidence rate of adverse reactions（ 26. 32% vs 21. 25%,P〉 0. 05）. There was a significant difference in the time to recurrence of varices between the two groups（ 11. 90 ±1. 89 months vs 7. 07 ± 1. 17 months,t = 2. 295,P = 0. 031）. Of all 156 patients,2（ 1. 28%） died during follow-up,with 1 patient in the dense ligation group and 1 in the non-dense ligation group. There was no significant difference in mortality rate between the two groups（ P〉 0. 05）. Conclusion Endoscopic dense ligation is a safe technique for the treatment of esophageal va

关 键 词：肝硬化 食管和胃静脉曲张 结扎术 治疗结果 

分 类 号：R575.2[医药卫生—消化系统]