内镜下套扎和硬化疗法预防肝硬化食管静脉曲张破裂再出血的比较分析  

Comparative analysis of EVL and EIS as secondary prevention of esophageal varices bleeding in liver cirrhosis patients

作　　者：张妍 丁惠国 ZHANG Yan;DING Huiguo(Health Care Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050;Center of Hepatic and Digestive Diseases,Beijing YouAn Hospital,Capital Medical University,China)

机构地区：[1]首都医科大学附属北京友谊医院医疗保健中心,北京100050 [2]首都医科大学附属北京佑安医院肝病消化中心

出　　处：《胃肠病学和肝病学杂志》2021年第10期1166-1170,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：病毒性肝炎和艾滋病等重大传染病防治专项(2017ZX10203202-004);北京市医院管理中心消化内科学科协同发展中心(XXZ0801)。

摘　　要：目的比较分析肝硬化食管静脉曲张破裂出血(esophageal varices bleeding,EVB)患者首次出血后内镜套扎疗法(endoscopic variceal ligation,EVL)和内镜硬化疗法(endoscopic injection sclerotherapy,EIS)单用作为二级预防的效果及安全性。方法回顾性分析2013年5月至2019年5月于首都医科大学附属北京佑安医院肝病消化中心行EVL或EIS二级预防肝硬化EVB患者的临床资料,随访1年。从静脉曲张消除显效率、有效率、无效率、早期再出血率、晚期再出血率及并发症方面比较EIS组和EVL组两组的疗效及安全性。结果共纳入154例患者,其中EIS组78例,EVL组76例。EIS组显效24例(30.8%),有效40例(51.3%),无效14例(17.9%);EVL组显效26例(34.2%),有效39例(51.3%),无效11例(14.5%);两组患者在静脉曲张消除显效率、有效率及无效率方面差异无统计学意义(P>0.05)。EIS组的早期再出血率(11.5%)高于EVL组(7.9%),远期再出血率(32.1%)高于EVL组(23.7%),但差异无统计学意义(P>0.05)。EIS组患者发热(EIS组:24.4%vs EVL组:15.8%)、进食哽噎感(EIS组:6.4%vs EVL组:3.9%)发生率高于EVL组,EIS组患者食管狭窄率为3.8%,EVL组未发生,但差异无统计学意义(P>0.05)。EVL组患者胸骨后疼痛(EIS组:15.4%vs EVL组:26.3%)的发生率高于EIS组患者(P>0.05)。两组的内镜治疗次数差异有统计学意义,达到相同疗效,EVL组所需治疗次数显著低于EIS组(P<0.05)。结论EVL和EIS均是二级预防肝硬化患者EVB的有效方法,疗效及安全性相当,但EVL可明显减少内镜治疗次数。Objective To compare the effect and safety of endoscopic variceal ligation(EVL)and endoscopic injection sclerotherapy(EIS)as secondary prevention in liver cirrhosis patients with esophageal varices bleeding(EVB).Methods To collect the cases of liver cirrhosis patients with EVB in the Center of Hepatic and Digestive Diseases,Beijing YouAn Hospital,Capital Medical University from May 2013 to May 2019,each of the patients was followed-up for one year after the first endoscopic therapy as secondary prevention of EVB and detailed record condition changes in the follow-up period.To compare the treatment effect in two groups from current and forward rebleeding rate,complications and so on.Results Finally 154 cases were qualified,76 cases in EVL group and 78 cases in EIS group.In EIS group,24 patients(30.8%)were greatly improved,40 patients(51.3%)responded to some degree,14 patients(17.9%)did not respond to the treatment.In EVL group,26 patients(34.2%)were greatly improved,39 patients(51.3%)responded to some degree,11 patients(14.5%)did not respond to the treatment.There was no significant difference in elimination of varices between EVL group and EIS group(P>0.05).Early rebleeding rate(EIS group:11.5%vs EVL group:7.9%),forward rebleeding rate(EIS group:32.1%vs EVL group:23.7%)were higher in EIS group,but the differences had no statistical significance(P>0.05).Complications comparison:fever(EIS group:24.4%vs EVL group:15.8%),eating choking(EIS group:6.4%vs EVL group:3.9%)were higher in EIS group.There were 3 cases(3.8%)with esophageal stenosis after EIS,there was not in EVL group,but the differences had no statistical significance(P>0.05);retrosternal pain(EIS group:15.4%vs EVL group:26.3%)was higher in EVL group while the differences had no statistical significance(P>0.05).While,the frequency of endoscopic therapy had significant difference.To achieve the same benefit,the frequency of EVL group was much lower(P<0.05).Conclusion EVL and EIS are both effective methods to treat EVB.The effect and safety may be same,but the

关 键 词：肝硬化 食管静脉曲张 二级预防 内镜套扎疗法 内镜硬化疗法 

分 类 号：R575.2[医药卫生—消化系统]