外科手术与内镜下治疗肝硬化食管静脉曲张出血远期疗效对比

The long-term efficacy of endoscopic treatment vs surgical treatment on the esophageal variceal bleeding

目的探讨外科手术与内镜下治疗肝硬化食管静脉曲张破裂出血的再出血及病死率的远期疗效。方法肝硬化门静脉高压症并发食管静脉曲张破裂出血患者93例,分为内镜下治疗组(44例)及外科手术治疗组(49例)。对两组患者治疗后的再出血及病死率进行回顾性研究。结果内镜治疗组中,5例(11.4%)发生再出血;外科手术治疗组中,4例(8.2%)发生再出血,二者差异无统计学意义(P>0.05)。内镜治疗组中,7例(16.0%)死亡;外科手术治疗组中,15例(30.6%)死亡,二者之间差异有统计学意义(P<0.05)。结论内镜下治疗和外科手术治疗对预防食管静脉曲张破裂出血的再出血有相近的作用,前者的病死率较低,而且操作简便易行,因此在防治食管静脉曲张出血中,应首选前者。

Objective To study the long- term efficacy of endoscopic treatment vs surgical treatment on the esophageal variceal bleeding. Methods Ninety - three cases of cirrhosis with portal hypertension and esophageal variceal bleeding were divided into two groups ： endoscopic treatment group and surgical treatment group. Rehaemorrhagia and case fatality rate were retrospectively analyzed. Results There were 5 cases （11.4 % ） of rehaemorrhagia in endoscopic treatment group and 4 cases （8.2 % ）in surgical treatment group（ P 〉 0.05 ）. Seven cases （16.0 % ） died in endoscopic group and 15 cases （30.6 % ） in surgical treatment group（ P 〈 0.05 ）. Conclusion Endoscopic treatment and surgical treatment have similar effects on the protection of rehaemorrhagia of esophageal varieeal bleeding. The case fatality rate of the endoscopic treatment group is lower than that of surgical treatment group. Endoscopic treatment is the first choice for the treatment of esophageal variceal bleeding.