食管胃底静脉曲张破裂大出血内镜下硬化治疗方法的改进

Improvement on endoscopic sclerotherapy of massive hemorrhage of esophageal varices in patients with cirrhosis

目的对传统的内镜硬化术(EVS)进行改良,并观察其疗效和并发症。方法对住院的99例肝硬化食管静脉曲张破裂大出血患者采用硬化剂治疗,对照组(1995年3月以前的32例)采用传统内镜硬化术治疗136例次,改良组(1995年4月至2002年4月的67例)采用改良方法治疗202例次,分析比较两组的出血率和并发症。改进的方法为:内镜下曲张静脉内多点大剂量快速注射硬化剂并用内镜顶端压迫,序贯三点垂直静脉穿刺。结果总止血成功率94.9%(94/99),静脉曲张消失率78.8%(78/99),术后3年出血率及病死率11.1%(6/54)。改良组的静脉曲张消失率(88.0%)高于对照组(59.4%),差异有非常显著意义。改良组术后胸骨后疼痛、梗噎及溃疡等并发症发生率比传统组低。结论与传统的治疗方法相比,改进后的方法疗效较好,且并发症较少,值得推广。

Objective To improve the traditional method of endoscopic vein sclerotherapy（ EVS ） and observe the efficacy and complications. Methods Ninety-nine inpatients with liver cirrhosis and esophageal variceal bleeding were treated by EVS. Among them, 32 patients in control group were treated before March 1995 by traditional EVS, 67 patients in improvement group were treated from April 1995 to April 2002 by improved EVS method, i.e. intraveneous sequential injection. The rebleeding rate and complications were compared between two groups. Results The total bemostasis rate was 94.9% （ 94/99 ） and the rate of variceal eradication was 78.8% （78/99）. The postoperation symptoms such as chest pain, obstructive feeling and ulcer were more less in improvement group than those in control group （ P 〈 0.01 ）. Conclusion The efficacy of two groups has no significant difference. Compared to control group, the complications are more less and the average hospitalization days is more short in improvement group.