摘要
目的肝硬化患者首次食管静脉曲张破裂出血后具有较高的再出血率和死亡率，通过内镜下重复硬化与套扎治疗消除曲张静脉，评价两者的有效性和安全性。方法计算机检索Medline、Embsae、Cochrane协作网、PubMed和CNKI等文库，采用Cochrane协作网提供的RevMan4．2软件进行Meta分析。结果共纳入4篇随机对照实验，结果显示内镜下重复硬化与套扎治疗在曲张食管静脉消除率方面的差异无统计学意义（OR=0．75，95％CI：0．48～1．15；P=0．19）；而套扎治疗后再出血发生率显著低于硬化治疗（OR=2．19，95％CI：1．44—3．31；P=0．0002）；在降低死亡率方面两者相似（OR=1．34，95％CI：0．82～2．17；P=0．24）。制作“倒漏斗图”分析发表偏倚显示，文献落点分布较对称，表明研究对纳入文献评价的发表偏倚相对较小。结论套扎治疗较硬化治疗在治疗肝硬化食管静脉曲张中能更好地预防再出血，但在曲张食管静脉消除率和死亡率方面两者相似。
Objective To evaluate the efficacy and safety of repeated endoscopic sclerotherapy injection （ESI） and endoscopic variceal ligation （EVL） in eradication of esophageal varices among patients who survive an episode of first variceal hemorrhage with a high risk of rehaemorrhagia and death. Methods The correlated literatures were identified from Medline, Embsae, the Library Cochrance, PubMed and CNKI. RevMan 4. 2 Software provided by the Library Cochrance was used for data analysis. Results A total of 4 randomized controlled trials were included. It was demonstrated that there was no significant difference in the esophageal varices eradication rate between repeated ESI and EVL （OR =0.75, 95% CI： 0.48-1.15; P =0.19）. However, the rehaemorrhagia rate of EVL after emergency hemostasis was significantly lower than that of ESI （OR = 2. 19, 95% CI： 1.44-3.31; P = 0. 000 2）. Meanwhile, there was no significant difference in mortality between ESI and EVL （ OR = 1.34, 95% CI： 0. 82-2.17 ; P = 0.24 ）. Little publication bias was found with funnel plot analysis. Conclusion EVL outperforms ESL in prevention of rehaemorrhagia in treatment of esophageal varices, while does no better than ESL in eradication of esophageal varices and mortality.
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2009年第4期385-388,共4页
Journal of Shanghai Jiao tong University:Medical Science
