中华消化内镜杂志
中華消化內鏡雜誌
중화소화내경잡지
CHINESE JOURNAL OF DIGESTIVE ENDOSCOPY
2013年
2期
67-70
,共4页
李弼民%朱萱%舒徐%王缨%吕农华%廖旺娣%刘志坚%陈幼祥%周晓东%徐龙
李弼民%硃萱%舒徐%王纓%呂農華%廖旺娣%劉誌堅%陳幼祥%週曉東%徐龍
리필민%주훤%서서%왕영%려농화%료왕제%류지견%진유상%주효동%서룡
食管静脉曲张%硬化剂治疗%套扎治疗%序贯治疗
食管靜脈麯張%硬化劑治療%套扎治療%序貫治療
식관정맥곡장%경화제치료%투찰치료%서관치료
Esophageal varices%Sclerotherapy%Ligation%Sequential therapy
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、EVIS1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)、EVLS1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.
目的 評價麯張靜脈套扎術(EVL)+不同硬化劑麯張靜脈硬化術(EVS)序貫治療肝硬化食管靜脈麯張破裂齣血的療效及安全性.方法 迴顧性總結314例肝硬化食管靜脈麯張破裂齣血內鏡治療患者的臨床資料,包括單純EVL治療者112例(EVL組)、單純魚肝油痠鈉硬化治療者48例(EVS1組)、單純聚桂醇硬化治療者40例(EVS2組)、套扎+魚肝油痠鈉硬化序貫治療者26例(EVLS1組)、套扎+聚桂醇硬化序貫治療者88例(EVLS2組),統計各組麯張靜脈治療有效率、靜脈麯張複髮率、併髮癥髮生率併進行對比分析.結果 EVL組、EVS1組、EVS2組、EVIS1組、EVLS2組麯張靜脈治療有效率比較差異均無統計學意義[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組和EVLS2組麯張靜脈完全消失率均明顯高于其他3組[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組與EVLS2組比較差異無統計學意義(P＞0.05).EVS1組再齣血率最高(18.8％,9/48) (P ＜0.05),其次是EVL組(11.6％,13/112),均高于EVS2組、EVLS1組和EVLS2組[7.5％(3/40)、7.7％ (2/26)、6.8％ (6/88),P＜0.05],後3組再齣血率相似(P＞0.05).治療後隨訪6 ～18箇月,EVL組靜脈麯張複髮26例(23.2％,26/112),EVS1組複髮8例(16.7％,8/48),EVS2組複髮6例(15.0％,6/40),EVLS1組複髮4例(15.4％,4/26),EVLS2組複髮9例(10.2％,9/88)；EVL組複髮率最高(P＜0.05),EVLS2組複髮率最低(P＜0.05),EVS1組、EVS2組和EVLS1組複髮率相似(P＞0.05).EVS1組總體併髮癥髮生率(32.2％,49/152)明顯高于其他4組(P＜0.05),而EVL組(14.5％,32/220)、EVLS2組(19.6％,22/112)、EVLS1組(22.7％,25/110)、EVLS2組(15.8％,34/229)4組間比較差異無統計學意義(P＞0.05).結論 EVL+魚肝油痠鈉EVS或+聚桂醇EVS序貫治療肝硬化食管靜脈麯張破裂齣血是安全而有效的,尤以EVL+聚桂醇EVS序貫治療效果顯著,有可能成為治療食管靜脈麯張齣血併防止再齣血的最佳選擇.
목적 평개곡장정맥투찰술(EVL)+불동경화제곡장정맥경화술(EVS)서관치료간경화식관정맥곡장파렬출혈적료효급안전성.방법 회고성총결314례간경화식관정맥곡장파렬출혈내경치료환자적림상자료,포괄단순EVL치료자112례(EVL조)、단순어간유산납경화치료자48례(EVS1조)、단순취계순경화치료자40례(EVS2조)、투찰+어간유산납경화서관치료자26례(EVLS1조)、투찰+취계순경화서관치료자88례(EVLS2조),통계각조곡장정맥치료유효솔、정맥곡장복발솔、병발증발생솔병진행대비분석.결과 EVL조、EVS1조、EVS2조、EVIS1조、EVLS2조곡장정맥치료유효솔비교차이균무통계학의의[85.7％ (96/112)、83.3％ (40/48)、92.5％ (37/40)、92.3％(24/26)、94.3％ (83/88),P＞0.05],단EVLS1조화EVLS2조곡장정맥완전소실솔균명현고우기타3조[88.5％(23/26)화87.5％(77/88)비58.0％(65/112)、62.5％(30/48)、70.0％(28/40),P＜0.05],이EVLS1조여EVLS2조비교차이무통계학의의(P＞0.05).EVS1조재출혈솔최고(18.8％,9/48) (P ＜0.05),기차시EVL조(11.6％,13/112),균고우EVS2조、EVLS1조화EVLS2조[7.5％(3/40)、7.7％ (2/26)、6.8％ (6/88),P＜0.05],후3조재출혈솔상사(P＞0.05).치료후수방6 ～18개월,EVL조정맥곡장복발26례(23.2％,26/112),EVS1조복발8례(16.7％,8/48),EVS2조복발6례(15.0％,6/40),EVLS1조복발4례(15.4％,4/26),EVLS2조복발9례(10.2％,9/88)；EVL조복발솔최고(P＜0.05),EVLS2조복발솔최저(P＜0.05),EVS1조、EVS2조화EVLS1조복발솔상사(P＞0.05).EVS1조총체병발증발생솔(32.2％,49/152)명현고우기타4조(P＜0.05),이EVL조(14.5％,32/220)、EVLS2조(19.6％,22/112)、EVLS1조(22.7％,25/110)、EVLS2조(15.8％,34/229)4조간비교차이무통계학의의(P＞0.05).결론 EVL+어간유산납EVS혹+취계순EVS서관치료간경화식관정맥곡장파렬출혈시안전이유효적,우이EVL+취계순EVS서관치료효과현저,유가능성위치료식관정맥곡장출혈병방지재출혈적최가선택.
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 sclerotherapy (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).Conclusion EVL plus EVS,either with sodium morrhuate or lauromacrogol EVS is safe and effective for EVB,especially EVL plus Lauromacrogol EVS,may become an optimal therapy to control esophageal variceal bleeding and rebleeding.
