内镜下套扎术治疗肝硬化食管曲张静脉破裂出血的效果分析

Analysis of efficacy of endoscopic variceal ligation in the treatment of patients with cirrhosis

目的探讨内镜下套扎治疗肝硬化食管静脉曲张疗效的影响因素。方法肝硬化食管静脉曲张患者165例行内镜下食管曲张静脉套扎术(EVL)治疗,分析肝硬化者113例与肝硬化断流术后者52例行EVL术后近期及远期疗效,并观察各种相关因素对EVL疗效的影响。结果EVL治疗后EV总消失率为88.48%,EV复发率27.27%。肝硬化断流手术组与肝硬化组比较,EV复发率低,差异有显著性意义(P<0.05);EVL术前肝功能状态越差,EV和EVB再发生率越高(P<0.01),生存率越低(P<0.05);EV复发组门静脉内径和脾静脉内径较非复发组宽,有显著性差异(P<0.01);EVL术后服用哌唑嗪可降低门静脉内径、减少EV复发(18.07%)、EVB再发率(15.66%),提高生存率(85.54%,P<0.01)。结论EVL是治疗EVB安全有效的方法,近期及远期疗效确切,EVL术后服用哌唑嗪可降低门静脉压力、减少EV复发和EVB再发生率。

Objective To study the relevant factors affecting the outcome of endoscopic variceal ligation （EVL）. Methods The 165 patients with esophageal variceal bleeding were treated by EVL. The patient were divided into liver cirrhosis group （n= 113） and shunt operation history groups （n= 52）. The outcome of patients in two groups were compared and the relevant factors affecting the final outcomes were observed. Results Total disappearrance rate of EV was 88. 48%. The rate of recurrence of EV was 27.27%. The recurrence rate was lower in shunt operation group than in cirrhosis group （P〈0. 05）. The recurrence rate of EVB was higher（p〈0.01）and survival rate was lower （p〈0. 05） in patients with Child-Pugh C class. In EV recurrence patient, the diameter of portal vein and spleen vein was widened. Prazosin administration after EVL brought down diameter of portal vein,decreased recurrence rate of EV. Conclusion EVL is a effective and safe measure in treating EVB. Prazosin can bring down pressure of portal vein, decrease recurrence rate of EV and EVB.