食管静脉曲张硬化与套扎及联合疗法疗效比较

Comparison of the effects of EVS,EVL and the combined therapy for 516 EV cases

目的探讨比较食管静脉曲张硬化(EVS)治疗术、套扎术(EVL)及联合治疗术三者治疗食管静脉曲张的效果。方法对516例肝硬化并食管静脉曲张出血(EVB)患者分别采用EVS、EVL治疗及二者联合治疗。其中EVS治疗251例,EVL治疗189例,EVS与EVL联合治疗76例。通过食管曲张静脉(EV)消失率、EV复发率以及再出血率等指标衡量、比较三者的疗效。结果3组EV消失率分别为58．57%、52．38%、80．26%;EV复发率分别为18．83%、21．21%、7．4%,EV消失前再出血率分别为4．38%、4．76%、2．6%,EV消失后再出血率分别为9．74%、10．1%、3．75%,联合治疗组各项指标均优于单纯EVS或EVL组(P＜0．05)。肝功能状况与疗效关系密切,Child—Pugh为C级者各项指标均低于A级和B级者(P＜0．05)。合并肝癌疗效明显低于未合并肝癌者(P＜0．01)。结论EVS和EVL为治疗EVB疗效可靠的首选方法,二者联合应用可提高疗效。

Objective To study and compare the effects of endoscopic variceal sclerotherapy （EVS）, endoscopic variceal ligation （EVL） and the combined therapy of both therapies. Methods EVS,EVL and the combined therapy were performed in 516 cases of liver cirrhosis with endoscopic variceal bleeding （EVB）. The patients were divided into three groups： EVS group （n=251）, EVL group （n=189） and the group of the combined therapy（n=76）. The different rates of eradication, recurrence and rebleeding of EV were compared and the effects in three groups were observed.Results The rate of eradication of EV was 58.57%, 52.38% and 80.26% in three groups; the rate of reccurrence of EV was 18.83%, 21.21% and 7.4%; the rate of rebleeding before eradication of EV was 4.38%, 4.76% and 2.6%; the rate of rebleeding after eradication of EV was 9.74%, 10.1% and 3.75%, respectively. The results indicated that the effects in the combined therapy group were better than in EVS group and EVL group （P〈0.05）,and liver function was closely associated with treatment effects, which were worse in the cases whose liver function was in grade C than in grade A and B according to Child- Pugh classification （P〈0.05）. The effects of patients with HCC were worse than those without HCC（P〈0.01）.Conclusion EVS and EVL, as effective and safe measures, should be the first choices in treating EVB, and the combined therapy of both could be better than above both.