食管静脉曲张套扎硬化序贯治疗的临床研究*

Efficacy of endoscopic sclerotherapy and endoscopicvariceal ligation combine sclerotherapy for severe esophageal varices*

摘要:

摘要：目的 研究食管静脉曲张内镜下硬化剂注射治疗（EIS）和套扎硬化序贯治疗（ELIS）的效果。方法 对2013年11月－2017年5月在该院行内镜下治疗的126例肝硬化重度食管静脉曲张患者进行回顾性分析。按内镜下治疗方法将其分为两组，即EIS组和ELIS组。比较两组间治疗后72 h内再出血率、治疗后静脉曲张消失率、治疗后随访期限内静脉曲张复发率、治疗次数、硬化剂用量及其并发症发生率。结果 126例肝硬化重度食管静脉张患者EIS和ELIS治疗后总有效率分别为92.75%和98.25%，两组比较差异无统计学意义（P =0.150）；随访期限内静脉曲张复发率分别为5.80%和10.52%，两组比较差异无统计学意义（P =0.328）。而在硬化剂用量及治疗次数方面，EIS和ELIS组分别为（69.12±9.45）和（38.45±13.39）ml以及（3.86±0.98）和（2.45±1.01）次，两组比较，差异均有统计学意义（P =0.000）。在72 h内再出血、急诊止血率、胸骨后疼痛、穿孔和狭窄等方面两组间比较，差异均无统计学意义。结论 EIS和ELIS治疗肝硬化门脉高压重度食管静脉曲张在疗效上无明显差异，但ELIS与EIS相比，可以明显减少硬化剂用量和治疗次数，可以彻底消除细碎的曲张静脉，阻断交通支，弥补单纯套扎治疗的不足，值得在临床推广。

Abstract:

Abstract: Objective To evaluate the efficacy of endoscopic sclerotherapy (EIS) and endoscopic variceal ligation combine sclerotherapy (ELIS) for esophageal varices. Methods Retrospective analysis of 126 patients with esophageal varices underwent endoscopic treatment from November 2013 to May 2017. According to the method of operation, they were randomly divided into two groups, namely, group EIS and group ELIS. The comparison between the two groups of rebleeding rate within 72 h, the incidence rate of varicose vein disappeared after the end of treatment, the variceal recurrence rate in 6~26 months after treatment, treatment times, dosage of hardener and incidence rate of complications. Results 126 cases of liver cirrhosis patients with esophageal varices, EIS and ELIS groups total effective rate were 92.75% and 98.25% respectively, P = 0.150, and during the follow-up period variceal recurrence rate were 5.80% and 10.52% respectively, P = 0.328, there was no statistical difference between the two groups. In aspect of the dosage of hardener and the number of treatment, EIS and ELIS groups were (69.12 ± 9.45) ml vs (38.45 ± 13.39) ml and (3.86 ± 0.98) times vs. (2.45 ± 1.01) times respectively, P = 0.000. There was statistical significance between the two groups. There was no significant difference between the two groups in rebleeding rate within 72 h, retrosternal pain, perforation and stenosis. Conclusion The efficacy of EIS and ELIS in treatment of esophageal varices is not significantly different, but compared with EIS, ELIS can significantly reduce the dosage of hardener and the number of treatment, save medical resources and alleviate the pain of patients.