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肝硬化食管静脉曲张破裂出血序贯治疗的临床应用价值 被引量:27

Endoscopic variceai ligation plus sclerotherapy for esophageal variceal bleeding
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摘要 目的评价曲张静脉套扎术(EVL)+不同硬化剂曲张静脉硬化术(EVS)序贯治疗肝硬化食管静脉曲张破裂出血的疗效及安全性。方法回顾性总结314例肝硬化食管静脉曲张破裂出血内镜治疗患者的临床资料,包括单纯EVL治疗者112例(EVL组)、单纯鱼肝油酸钠硬化治疗者48例(EVS1组)、单纯聚桂醇硬化治疗者40例(EVS2组)、套扎+鱼肝油酸钠硬化序贯治疗者26例(EVLS1组)、套扎+聚桂醇硬化序贯治疗者88例(EVLS2组),统计各组曲张静脉治疗有效率、静脉曲张复发率、并发症发生率并进行对比分析。结果EVL组、EVS1组、EVS2组、EVLS1组、EVLS2组曲张静脉治疗有效率比较差异均无统计学意义[85.7%(96/112)、83.3%(40/48)、92.5%(37/40)、92.3%(24/26)、94.3%(83/88),P〉0,05],但EVLS1组和EVLS2组曲张静脉完全消失率均明显高于其他3组[88.5%(23/26)和87.5%(77/88)比58.0%(65/112)、62.5%(30/48)、70.0%(28/40),P〈0.05],而EVLS1组与EVLS2组比较差异无统计学意义(P〉0.05)。EVS1组再出血率最高(18.8%,9/48)(P〈0.05),其次是EVL组(11.6%,13/112),均高于EVS2组、EVLS1组和EVLS2组[7.5%(3/40)、7.7%(2/26)、6.8%(6/88),P〈0.05],后3组再出血率相似(P〉0.05)。治疗后随访6~18个月,EVL组静脉曲张复发26例(23.2%,26/112),EVS1组复发8例(16.7%,8/48),EVS2组复发6例(15.0%,6/40),EVLS1组复发4例(15.4%,4/26),EVLS2组复发9例(10.2%,9/88);EVL组复发率最高(P〈0.05),EVLS2组复发率最低(P〈0.05),EVS1组、EVS2组和EVLS1组复发率相似(P〉0.05)。EVS1组总体并发症发生率(32.2%,49/152)明显高于其他4组(P〈0.05),而EVL组(14.5%,32/220)、EVLS2组(19.6%,22/112)、EVLSI组(22.7%,25/110)、EVLS2组(15.8%,34/229)4组间比较差异无统计学意义(P〉0.05)。结论EVL+鱼肝油酸钠EVS或+聚桂醇EVS序贯治疗肝硬化食管静脉曲张破裂出血是安全而有效的,尤以EVL+聚桂醇EVS序贯治疗效果显著,有可能成为治疗食管静脉曲张出血并防止再出血的最佳选择。 Objective To observe the efficacy and safety of endoscopic variceal ligation (EVL) and esophageal variceal sclerotherapy (EVS) with different hardeners for esophageal variceal bleeding (EVB). Methods Clinical data of 314 patients with EVB were retrospectively reviewed. The patients were divided into 5 groups according to the endoscopic treatments they have received, i. e. , endoscopic variceal ligation (EVL) group ( n = 112) , sodium morrhuate sclerotherapy ( EVS1 ) group ( n = 48 ) , lauromacrogol sclero- therapy (EVS2) group ( n = 40), EVL plus sodium morrhuate sclerotherapy ( EVLS1 ) group ( n = 26) and EVL plus lauromacrogol sclerotherapy (EVLS2) group (n = 88 ). The efficacy, variceal recurrence rate and complication rate were evaluated. Results There was no significant difference in efficacy of stop bleeding among 5 groups, which was 85.7% (96/112) in EVL group, 83.3% (40/48) in EVS1 group, 92. 5% (37/40) in EVS2 group, 92. 3% (24/26) in EVLS1 group and 94. 3% (83/88) in EVLS2 group (P 〉 0. 05). The complete cure rates in EVLS1 group (88. 5%, 23/26) and EVLS2 group (87.5%, 77/88) were significantly higher than those in 3 other groups ( P 〈 0. 05 ). Rebleeding rates in EVS1 group (18.8% , 9/48) and EVL group (11.6% , 13/112) were significantly higher than those in other 3 groups (P 〈0. 05). The patients were followed up for 6-18 months, and the varices recurrence rate was highest in group EVL (23.2% , 26/112) and lowest in EVLS2 ( 10. 2% , 9/88, P 〈 0. 05). The complication rate in group EVS1 (32. 2% , 49/152) was significantly higher than that in other 4 groups (P 〈0. 05). Conclu- sion EVL plus EVS, either with sodium morrhuate or lauromaerogol EVS is safe and effective for EVB, es- pecially EVL plus Lauromacrogol EVS, may become an optimal therapy to control esophageal varieeal bleed- ing and rebleeding.
出处 《中华消化内镜杂志》 2013年第2期67-70,共4页 Chinese Journal of Digestive Endoscopy
关键词 食管静脉曲张 硬化剂治疗 套扎治疗 序贯治疗 Esophageal varices Sclerotherapy Ligation Sequential therapy
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