内镜下食管静脉曲张结扎术后早期再出血的预防和治疗

Prevention and treatment of early rebleeding after endoscopic variceal ligation

目的 总结内镜下食管静脉曲张结扎术 (EVL)后早期再出血及出血后死亡的发生率 ,并评价 10年来结扎术后早期再出血药物应用的趋势以及药物预防措施的效果。方法 总结我院 10年来 5 93例次肝硬化和 (或 )肝癌单纯EVL治疗的资料 ,统计接受EVL治疗后早期再出血及出血后死亡的发生率 ,分析预防结扎术后早期再出血药物应用的趋势以及药物预防措施的效果。结果 EVL术后早期再出血的发病率为 4.7% ( 2 8/5 93 ) ,出血后死亡率为 64 .3 % ( 18/2 8)。质子泵抑制剂、生长抑素、胃黏膜保护剂和凝血酶的使用 ,并不能使早期再出血率及出血后死亡率下降。结论 目前的药物预防并未带来EVL后早期再出血及出血后死亡率的下降 。

Objective To evaluate the preventative and therapeutic effects of drug application on the early rebleeding after EVL.Methods The records of the patients suffered with cirrhosis and/or hepatocellular carcinoma and accepted EVL in our hospital during the past 10 years were summarized.Totally 593 procedures of EVL had been performed in the period.Early rebleeding rate after EVL and death rate after rebleeding were calculated.The medicine application for the prevention of early rebleeding after EVL and the effect were also analyzed.Results The morbidity and mortality of early rebleeding after EVL were 4.7% (13/28) and 64.3% (18/28).The frequency of using proton pump inhibitor,octreotide,membrane protection agents and thrombin increased dramatically by year,but it didn't accompany with the decrease of morbidity and mortality of early rebleeding after EVL.Conclusion Drug prophylaxis doesn't decrease the early rebleeding rate after EVL and the death rate after rebleeding.The death rate after rebleeding may be induced by proton pump inhibitor application.