不同方法治疗肝硬化食管静脉曲张破裂出血的临床疗效比较

Comparison of Efficacy and Safety of Different Treatments for the Esophageal Variceal Bleeding in Patients with Hepatic Cirrhosis

目的:观察采取不同方法治疗肝硬化食管静脉曲张破裂出血(EVB)的临床疗效。方法采用回顾分析法,在我院2010年1月~2013年12月存档资料中选择123例肝硬化EVB患者作为本组研究对象,根据治疗方法的不同对患者进行分组,分为药物组(奥曲肽+普萘洛尔)40例、内镜下曲张静脉套扎术组(EVL)41例及联合组(药物+EVL)42例。观察治疗后每组患者止血率、再出血发生率、不良反应发生率及死亡率。结果联合组的止血率高于其他两组,且差异显著;联合组的再出血发生率及死亡率也明显低于其它两组,各组间差异明显,具有统计学意义(P<0.05),三组不良反应的发生率无显著差异,无统计学意义(P>0.05)。结论药物联合EVL治疗肝硬化EVB疗效显著,不良反应与单纯药物治疗或EVL相当,是肝硬化EVB安全、有效的治疗方法,可作为首选治疗方案。

Objective To compare the ef icacy and safety of the dif erent treatments for the esophageal variceal bleeding(EVB)caused by liver cirrhosis.Methods The patients who were diagnosed as EVB fol owed by cirrhosis between January 2010 and december 2012 were observed and divided into 3 groups as pharmacological therapy(octreotide plus propranolol)group,endoscopic variceal ligation(EVL)group and combination therapy(pharmacological therapy plus EVL)group.we compared the 3 groups by the successful hemostatic rate,incidence of rebleeding,and overal mortality after they had been conducted.Results 123 cases were enrol ed in this study and there were 40 cases in pharmacological therapy group,41 ones in EVL group and 42 ones in combination therapy group.The successful hemostatic rate in the combination therapy group(92.9%,39/42)is obviously higher than pharmacological therapy group(67.5%,27/40)or EVL group(80.5%,33/41)(P<0.05),the rebleeding rate of combination therapy group(2.3%,1/42)is significant lower than pharmacological therapy group(32.5%,13/40)or EVL group(12.1%,5/41)(P<0.05),the mortality of the 3 groups is 22.3%(1/4),(7.3%3/41),15.0%(6/40)respectively(P<0.05).The incidence of adverse ef ect in combination group is more than other two groups but without statistical y significant dif erence(P>0.05).Conclusion Combination therapy goup(Pharmacological therapy plus EVL)had a bet er ef ect and safety for EVB in patients with hepatic cirrhosis compared to pharmacological therapy group or EVL group alone and should be recommended as the first therapeutic choice for it.