药物治疗联合套扎术预防上消化道出血的临床研究

Prevention of Esophageal Variceal Rebleeding with A Combined Treatment of Drugs and Endoseopical Variceal Ligation

目的观察和评估药物治疗对食管静脉曲张套扎术后的疗效。方法将99例食管静脉曲张的患者随机分为联合治疗组(50例)和对照组(49例),分别口服普奈洛尔和单硝酸异山梨酯及安慰剂,并在治疗1～3个月、12～15个月后使用胃镜和彩色多普勒观察和比较。结果1～3个月后联合治疗组在食管静脉曲张和门脉高压性胃病的程度,肝源性溃疡和上消化道再出血的发生率和对照组相同,但平均血流速度和门脉血流量均比对照组低,而在术后12～15个月联合治疗组在上述几个指标均比对照组低。结论食管静脉曲张套扎术后,通过联合药物治疗,能够降低平均血流速度和门脉血流量,从而缓解门脉高压所致的食管静脉曲张和门脉高压性胃病,降低肝源性溃疡的发生率,预防再出血。

Objective To investigate the efficacy of drugs and endoscopic variceal ligation (EVL) combined treatment to prevent rebleeding in patients wi th liver cirrhosis. Methods 99 patients with esophageal varices were randomly d ivided into two groups: the therapeutic group was treated with oral propranolol/ isosorbide mononitate, and control group was given with placebo. The patients we re observed by endoscopy and colored doppler ultrasound. Results There was no remarkable difference in the first 3 months after treatment but with significan t different in 12-15 months after treatment between two groups on the extent of the varices, ported hypentensive gastropahty (PHG) and the incidence of hepatoge nous ulcer and rebleeding. The average of blood flow rate and the blood flow of portal vein was decreased in the therapeutic group. Conclusion Long-term treati ng with propranolol/isosorbide mononitate combined with endoscopic variceal liga tion (EVL) is effective on reducing the extent of varices and PHG, and the incid ence of hepatogenous ulcer and rebleeding.