内镜下结扎术联合心得安预防肝硬化食管静脉曲张出血的疗效与安全性研究

The efficacy and safety of ligation plus oral propranolol on esophageal variceal bleeding in cirrhotic patients

目的探讨内镜下结扎术联合心得安预防肝硬化食管静脉曲张出血的近期疗效和安全性。方法将103例肝硬化门脉高压食管静脉曲张患者随机分为3组:结扎+心得安组37例,先进行食管静脉曲张结扎术后,再服用心得安维持治疗;结扎组32例;心得安组34例。定期随访,比较3组的静脉曲张消失率、首次出血率、静脉曲张复发率、并发症和不良反应。结果静脉曲张消失率:结扎+心得安组与结扎组相似(88.2%vs.81.3%,P>0.05),两组均明显高于心得安组的66.7%(P<0.05)。首次出血率在结扎+心得安组为8.9%,明显低于结扎组的15.6%与心得安组的30.0%(P<0.05)。静脉曲张复发率:结扎+心得安组、结扎组与心得安组分别为11.74%、21.9%、33.3%(P<0.05)。达到静脉曲张完全消失所需的平均治疗次数:结扎+心得安组与结扎组分别为1.9±1.0和2.8±0.7(P<0.05)。达到静脉曲张完全消失所需的平均结扎环数:结扎+心得安组与结扎组分别为7.0±3.0和11.0±2.0(P<0.05)。3组均无治疗相关死亡报告,结扎组有3例(9.4%)术后并发出血,结扎+心得安组无一例发生术后出血。结论结扎术联合心得安预防EVB,效果显著,安全性高,有肯定的临床价值。

Objectives To explore the short-term efficacy and safety of endoscopic ligation plus oral propranolol in cirrhosis with portal hypertension and esophageal variceal bleeding.Methods One hundred and three cirrhotic patients with portal hypertension and esophageal variceal were randomly divided into three groups：ligation group（32 patients）,propranolol group（34 patients）,ligation plus propranolol group（37 patients）who received oral propranolol after ligational operation.Patients in three groups were regularly followed-up.The varicose disappearance rate,first hemorrhage,varicose recurrence,adverse complications were compared among three groups.Results The varicose disappearance rates in propranolol plus ligation group and ligation group were similar（88.2% vs.81.3%,P 〉 0.05）,but they were significantly higher than that of propranolol group（66.7%,P 〈 0.05）.First hemorrhage rate of ligation plus propranolol（8.9%）was significantly lower than that of ligation group（15.6%）and propranolol（23.3%）（P 〈 0.05）.The varicose recurrence rate of ligation plus propranolol was significantly lower than that of ligation group（21.9%）and propranolol group（33.3%）（P 〈 0.05）.Conclusions Ligation plus oral propranolol treatment for esophageal variceal bleeding in cirrhotic patients is safe and effective.