EVL和PTVE治疗食管静脉曲张破裂出血的远期效果对比研究  

Comparative study of long-term effects of PTVE and EVL in the treatment of esophageal variceal bleeding

作　　者：刘娟娟 薛挥[2] 李伟之[2] 李培杰[2] 唐德军 LIU Juanjuan;XUE Hui;Li Weizhi;LI Peijie;TANG Dejun(Gastroenterology Department,GM Universal Railway Xi'an Hospital,Xi'an 710054;Gastroenterology Department,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]通用环球中铁西安医院消化内科,陕西西安710054 [2]西安交通大学第一附属医院消化内科,陕西西安710061

出　　处：《临床医学研究与实践》2022年第32期62-65,共4页Clinical Research and Practice

摘　　要：目的比较内镜下静脉曲张套扎术(EVL)和经皮经肝曲张静脉栓塞术(PTVE)治疗食管静脉曲张破裂出血(EVB)的远期效果。方法选取2013年4月至2015年12月因肝硬化门脉高压导致EVB于本院消化内科行EVL或PTVE治疗的74例患者,并将其分为EVL组(38例,行EVL治疗)与PTVE组(36例,行PTVE治疗),术后6周及术后12、24、36个月通过门诊、电话、再就诊等方式对两组患者进行术后再出血、生存情况等资料的随访,手术成功且剔除失访的患者纳入两组的术后效果分析。结果两种手术的成功率与两组的并发症总发生率比较,差异无统计学意义(P=0.279;P=0.621)。随访6周及随访12、24、36个月,两组的累积未再出血率比较,差异均无统计学意义(P=0.335;P=0.749;P=0.773;P=0.976)。随访12、24个月,两组的平均出血次数比较,差异无统计学意义(P=0.419,P=0.116);随访36个月,EVL组的平均出血次数显著高于PTVE组(P=0.031)。随访期间,EVL组的平均治疗次数、反复治疗率显著高于PTVE组(P=0.000)。随访12、24、36个月,两组的累积生存率比较,差异均无统计学意义(P=0.443;P=0.713;P=0.934)。随访36个月,两组的生存曲线比较,差异无统计学意义(P>0.05)。两组的累积死亡率及死亡原因分布比较,差异无统计学意义(P>0.05)。结论EVL与PTVE治疗EVB均安全、有效,两者远期疗效相当。Objective To compare the long-term effects of endoscopic esophageal varix ligation(EVL)and percutaneous transhepatic variceal embolization(PTVE)in the treatment of esophageal variceal bleeding(EVB).Methods A total of 74 patients with EVB caused by cirrhosis and portal hypertension who underwent EVL or PTVE treatment in the gastroenterology department of our hospital from April 2013 to December 2015 were selected and divided into EVL group(38 cases,EVL treatment)and PTVE group(36 cases,PTVE treatment).The patients in the two groups were followed up for postoperative rebleeding and survival through outpatient,telephone and re-visit at 6 weeks,12,24 and 36 months after operation.Results There were no significant differences in the success rate of two operations and total incidence of complications between the two groups(P=0.279;P=0.621).There was no significant difference in the cumulative rate of no-rebleeding between the two groups at 6 weeks and 12,24,36 months(P=0.335;P=0.749;P=0.773;P=0.976).During the follow-up of 12 and 24 months,there was no significant difference in the average bleeding frequency between the two groups(P=0.419,P=0.116);during the follow-up period of 36 months,the average bleeding frequency in the EVL group was significantly higher than that in the PTVE group(P=0.031).During the follow-up period,the average treatment times and repeated treatment rate in the EVL group were significantly higher than those in the PTVE group(P=0.000).There was no significant difference in the cumulative survival rate between the two groups after 12,24 and 36 months of follow-up(P=0.443;P=0.713;P=0.934).After 36 months of follow-up,there was no significant difference in survival curve between the two groups(P>0.05).There were no significant differences in the cumulative mortality and the distribution of causes of death between the two groups(P>0.05).Conclusion Both EVL and PTVE in the treatment of EVB are safe and effective,and their long-term efficacy is comparable.

关 键 词：食管静脉曲张破裂出血 内镜下曲张静脉套扎术 经皮经肝曲张静脉栓塞术 

分 类 号：R65[医药卫生—外科学]