门静脉高压症食管胃底静脉曲张出血的手术与内镜套扎的疗效分析

A comparison between operative devascularization and endoscopic ligation for the treatment of bleeding gastroesophageal varices in 623 patients with portal hypertension

目的评价贲门周围血管离断术与内镜套扎治疗食管胃底静脉曲张出血的疗效。方法回顾性分析手术（150例）和内镜套扎（473例）治疗的门静脉高压症食管胃底静脉曲张出血患者的临床资料。结果手术组的紧急止血有效率为8／9,套扎组为89．8％（159／177）。断流手术后患者外周血白细胞及血小板计数均升至正常,与套扎组相比差异有统计学意义（P〈0．01）。手术组1、3、5年再出血率分别为2．5％、5．8％和14．6％,套扎组分别为39．3％、65．4％和96．1％,两组之间相比差异有统计学意义,P值均〈0．01;手术组1、3、5年生存率分别为99．2%、94．2％和75．6％,套扎组分别为82％、62．6％和44．1％,两组之间相比差异有统计学意义,P值均〈0．01。结论内镜套扎可作为紧急止血治疗的首选,但对肝功能代偿良好者亦应考虑手术治疗。断流术是可行性较强的方法,选择性手术的效果优于仅行内镜套扎治疗者。

Objective To evaluate operative devascularization and endoscopic varix ligation for bleeding gastroesophageal varices due to portal hypertension. Methods We retrospectively analyzed the clinical data of 623 patients with bleeding gastroesophageal varices treated with operative devascularization （150 cases） and endoscopic ligation （473 cases）. Results The success rate of bleeding control in operative group was 8/9 and was 89. 8% （159/177） in endoscopic group. Postoperative WBC and platelet count reached normal level, which was in significant difference from that in endoscopic group （P 〈 0. 01 ）. The postoperative rebleeding rate of 1, 3 and 5 years was 2. 5%, 5. 8% and 14. 6% respectively, significantly lower than that of 39. 3% , 65.4% and 96. 1% in endoscopic group （P 〈0. 01 ）. There was a significant difference for the survival rate of 99.2%, 94. 2% and 75.6% in 1, 3 and 5 years post-operatively compared to that of 82%, 62. 6% and 44. 1% in endoscopic group （P 〈 0.01 ）. Condnsion Endoscopic ligation is effective in the control of bleeding gastroesophageal varices. In patients with well compensated liver function operative devascularization is a better alternative.