内镜套扎术和硬化疗法治疗食管静脉曲张破裂出血的比较研究被引量：7

Comparative Study of Endoscopic Variceal Ligation and Endoscopic Sclerotherapy in Treat- ment of Variceal Hemorrhage

导出

摘要目的：比较内镜套扎术（ＥＶＬ）和硬化疗法（ＥＩＳ）治疗食管静脉曲张破裂出血的疗效和安全性。方法：８４例肝硬化伴食管静脉曲张破裂出血患者随机分为２组，ＥＶＬ组４０例，ＥＩＳ组４４例。ＥＶＬ组患者应用Ｓｔｉｅｇｍａｎｎ－Ｇｏｆｆ结扎设备，每次结扎间隔２周；ＥＩＳ组患者在同样时间间隔内静脉内注射乙氧硬化醇。结果：ＥＶＬ组患者曲张静脉消除率为７５．００（３０／４０，ＥＩＳ组为６３．６０（２／４４）（Ｐ＞０．０５）；ＥＶＬ组患者曲张静脉消除期限为１１．５周±６．０周，ＥＩＳ组为１８．０周±１４．０周（Ｐ＝０．０３６）；ＥＶＬ组患者出血复发率为３０％（１２／４０），ＥＩＳ组为５０％（２２／４４）（Ｐ＝０．０３）；ＥＶＬ组５例和ＥＩＳ组１３例患者发生各种并发症（Ｐ＜０．００５）；ＥＶＬ组患者食管静脉曲张复发率为５２．５％（２１／４０），ＥＩＳ组为２７．３％（１２／４４）（Ｐ＜０．０５）；ＥＶＬ组２例患者发生门静脉高压性胃病；ＥＶＬ组７例和ＥＩＳ组９例患者死亡，ＥＶＬ组５例和ＥＩＳ组１０例患者治疗失败。结论：ＥＶＬ组患者食管静脉曲张消除较ＥＩＳ组快，并发症发生率低，出血复发率较低但静脉曲张复发率较高，治疗后易发生门静脉高? Background/Aims: To evaluate the safety and efficacy of endoscopic variceal ligation (EVL) compared with endoscopic sclerotherapy (EIS). Methods: The Stiegmann-Goff device was used for EVL and polidocanol was used as sclerosant for EIS at intervals once every two weeks. Results: The variceal eradication rate was similar in both two groups (EVL: 75.0%, EIS: 63.6%, P>0.05), but the variceal eradication was more rapid in patients undergoing EVL than treating EIS (11.5 weeks±l6.0 weeks vs 18.0 weeks±14.0 weeks, P=0.036), and with fewer complications (5 vs 13, P< 0.005). The rate of recurrent bleeding was lower in patients treated by EVL than those by EIS (30% vs 50%, P=0.03). After treatment, the variceal recurrence rate was more frequent in patients treated by EVL than by EIS within 1~3 years (52.5% vs 27.3%, P<0.05). Portal hypertensive gastropathy was found in two pa- tients who underwent EVL. In EVL group, 7 patients died and 5 had treatment failure; while in EIS group, 9 patients died and 10 had treatment failure. Conclusions: EVL is superior to EIS in terms of the recurrent bleeding rate and the occurrence of complications, but in EVL group more patients had recurrence of varices and development of portal hypertensive gastropathy. When endoscopie treatment is used for prevention of recurrent variceal bleeding, EVL should be the first choice.

作者邱夏地顾国妹施建平汤丽芳赵引芳李华

机构地区上海市南汇县中心医院消化内科

出处《胃肠病学》 2000年第4期226-228,共3页 Chinese Journal of Gastroenterology

关键词内窥镜食管胃静脉曲张结扎术硬化疗法破裂出血 Hemostasis, Endoscopic Esophageal and Gastric Varices Ligation Sclerotherapy

分类号 R575.2 [医药卫生—消化系统]

引文网络
相关文献

参考文献9

1deFranchisR,PrimignariM.Whydovaricesbleed?GastroenterolClinNorthAm,1992,21:85～101.
2姚礼庆,吴肇汉.经胃镜结扎及硬化剂注射治疗重度食管静脉曲张102例报告[J].临床,1996,3(4):206-208. 被引量：2
3HashizumeM,KitanoS,KoyanagiN,TanoueK,OhtaM,WadaH,YamagaH,HigashiH,IsoY,IwanagaT,etal.Endoscopicinjectionsclerotherapyfor1,000patientswithesophagealvarices:anine-yearprospectivestudy.Hepatology,1992,15:69～75.
4HouMC,LinHC,KuoBI,ChenCH,LeeFY,LeeSD.Comparisonofendoscopicvaricealinjectionsclerotherapyandligationforthetreatmentofesophagealvaricealhemorrhage:aprospectiverandomizedtrial.Hepatology,1995,21:1517～1522.
5LoGH,LaiHC,ChengJS,HwuJH,ChangCF,ChenSM,ChiangHT.Aprospectiverandomizedtrialofsclerotherapyversusligationinthemanagementofbleedingesophagealvarices.Hepatol.ogy,1995,22:466～471.
6于中麟,于永征.食管静脉曲张的内镜下硬化与结扎疗法的联合应用[J].中华消化杂志,1996,16(2):122-122. 被引量：6
7AvgerinosA,ArmonisA,ManolakopoulosS,PoulianosG,RekoumisG,SgourouA,GoumaP,RaptisS.Endoscopicsclerotherapyversusvaricealligationinthelong-termmanagementofpatientswithcirrhosisaftervaricealbleeding.Aprospectiverandomizedstudy.JHepatol,1997,26:1034～1041.
8BaronciniD,MilandriGL,BorioniD,PiemonteseA,CennamoV,BilliP,DalMontePP,D'ImperioN.Aprospectiverandomizedtrialofsclerotherapyversusligationintheelectivetreatmentofbleedingesophagealvarices.Endoscopy,1997,29:235～240.
9TanoueK,HashizumeM,WadaH,OhtaM,KitanoS,SugimachiK.Effectsofendoscopicinjectionsclerotherapyonportalhypertensivegastropathy:aprospectivestudy.GastrointestEndosc,1992,38:582～585.